RESEARCH THAT MATTERS
STRESS, HEALTH, AND WELLBEING OF LGBT PEOPLE IN COLOMBIA Results from a National Survey
APRIL 2020
The Colombia Collaborative Project
Soon Kyu Choi, Shahrzad Divsalar, Jennifer Flórez-Donado, Krystal Kittle, Andy Lin Ilan H. Meyer, Prince Torres-Salazar (authors listed alphabetically) Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 1
CONTENTS
EXECUTIVE SUMMARY...... 2 INTRODUCTION...... 5 COLOMBIA AND THE RIGHTS OF LGBT PEOPLE...... 5 VIOLENCE AGAINST LGBT PEOPLE IN COLOMBIA...... 5 YOUTH IN SCHOOL ...... 7 HEALTH OF LGBT PEOPLE...... 7 AIMS OF THIS STUDY...... 9 METHODS...... 12 SAMPLE...... 12 QUESTIONNAIRE...... 14 DATA PREPARATION AND STATISTICAL ANALYSIS...... 14 FINDINGS...... 16 DEMOGRAPHIC CHARACTERISTICS OF LESBIAN AND BISEXUAL WOMEN, GAY AND BISEXUAL MEN, AND TRANSGENDER SURVEY RESPONDENTS IN COLOMBIA...... 16 PHYSICAL HEALTH, MENTAL HEALTH, AND SUBSTANCE ABUSE OF LESBIAN/GAY AND BISEXUAL WOMEN, GAY AND BISEXUAL MEN, AND TRANSGENDER SURVEY RESPONDENTS IN COLOMBIA...... 22 MINORITY STRESSORS OF LESBIAN/GAY AND BISEXUAL WOMEN, GAY AND BISEXUAL MEN, AND TRANSGENDER RESPONDENTS IN COLOMBIA...... 28 INTERNALIZING MINORITY STRESS PROCESSES...... 35 AGE OF COMING OUT MILESTONES (LGB) AND GENDER IDENTITY MILESTONES (TRANSGENDER)...... 39 CONVERSION THERAPY...... 40 COMMUNITY CONNECTEDNESS...... 41 STUDY LIMITATIONS...... 43 CONCLUSIONS...... 44 RECOMMENDATIONS...... 45 REFERENCES ...... 46 AUTHORS...... 49 ACKNOWLEDGMENTS...... 49 SUGGESTED CITATION...... 50 APPENDICES...... 51 APPENDIX 1: LEGAL STATUS OF LGBT PEOPLE IN COLOMBIA ...... 51 APPENDIX 2: STUDY QUESTIONNAIRE IN SPANISH...... 59 APPENDIX 3: STUDY QUESTIONNAIRE IN ENGLISH...... 84 APPENDIX 4: QUESTIONNAIRE MEASURE SOURCES IN ENGLISH...... 106 Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 2
EXECUTIVE SUMMARY
Colombia is a country of contradictions when it comes to LGBT lives. On the one hand, there are impressive gains in civil rights protections for LGBT people, such as recognition of same-sex marriage, eligibility for retirement pensions, and legal protection from discrimination on the basis of sexual orientation and gender identity. On the other hand, there continues to be serious violence and discrimination against LGBT people, particularly gay/bisexual men and transgender people. There is also a continued risk of reversal of achieved rights as the conservative movement strongly opposes those rights.
This report aims to shed light on the LGBT community in Colombia by providing, for the first time, a comprehensive view of core health and well-being knowledge. The study provides a broad picture about LGBT people in Colombia in these areas: (a) demographic characteristics, including socioeconomic status, familial relationships, religion, geographical region; (b) experiences of stress, discrimination, and violence; (c) health and well-being, including psychological distress (e.g., depressive symptoms), drug use, alcohol use, and suicidality; and (d) connection with the LGBT community.
Overall, the study results show that LGBT people live across Colombia and come from all social strata. They experience high levels of discrimination and violence, and a significant proportion of LGBT people have experienced psychological distress and suicidal ideation.
METHODS The study used in-person and social media methods to recruit a sample of LGBT people who reside in Colombia. Because it is not feasible to obtain a probability (representative) sample, we aimed for a sample that is diverse in sexual identities, gender, gender identity, geographic residence, and socioeconomic status. Respondents were provided a link to an online self-administered online survey. Recruitment lasted five months from February to July 2019.
RESULTS This study is the largest and most comprehensive study conducted on LGBT people in Colombia. The final sample includes 4,867 LGBT people, including 1,243 cisgender and gender non-binary lesbian/ gay women, 895 cisgender and gender non-binary bisexual women, 2,163 cisgender and gender non- binary gay men, 334 cisgender and gender non-binary bisexual men, and 232 transgender people. Cisgender groups include 307 gender non-binary respondents based on their sexual identification.
Respondent characteristics
Most of the respondents (76%) were between the ages of 18 and 29 years old, about 20% of the respondents were aged 30–50, and 5% of the LGBT sample was aged 50 and older. The relatively young age of the respondents reflects the fact that more younger people, generally, identify as LGBT. It is also a limitation of the study—a result of our reliance on social media, which is more heavily used by young people.
Our sample was diverse in terms of gender, gender identity, residential geographic distribution, and Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 3
social class. Although 44% of our LGBT respondents were college educated, another 44% earned less than the minimum salary in Colombia, and 37% had a socioeconomic status level of 3, in the middle of the 1–6 Colombian social strata classification. Significantly more transgender respondents25%) ( were at the lowest economic status (level 1) compared to cisgender and gender non-binary LGB men and women (8%–13%).
Almost half of the LGBT respondents had no formal religion, identifying themselves as atheist, agnostic, spiritual, or non-religious. This high proportion of non-religious people may reflect the concern among LGBT people about rejection from some religious institutions, including the Catholic Church, which is Colombia’s biggest religious denomination.
Health and Well-being
In terms of health, despite reporting that they had good, very good, or excellent general health, 72% of the respondents reported at least moderate psychological distress.
Consistent with the high rate of psychological distress, 55% of respondents had suicidal thoughts in their lifetime, and one in four (25%) had attempted suicide at least once. Bisexual women (33%) and transgender people (31%) had the highest rates of suicide attempts, with one in three people reporting they had attempted suicide at least once.
Overall, one in five (21%) LGBT respondents have received treatment from someone who tried to change their sexual orientation or to make them identify with their assigned sex at birth (“conversion therapy”). An even higher proportion (35%) of transgender respondents reported of having received this treatment.
Victimization and Discrimination
LGBT respondents experienced high levels of victimization and discrimination. • Experiences of victimization, such as being threatened with violence, beaten, physically attacked, or sexually assaulted, were high among LGBT respondents, but especially high among transgender respondents and gay/bisexual men. This is consistent with reports on the targeting of transgender women and gay/bisexual men, by paramilitary groups and others in Colombian society.
Someone threatened you with violence You were beaten or physically attacked You were sexually assaulted
47% 43% 40% 36%
29% 27% 27% 24% 25% 21% 21% 22% 20% 19% 17%
TRANSGENDER CIS- CIS-GAY CIS- CIS- TRANSGENDER CIS- CIS-GAY CIS- CIS- TRANSGENDER CIS- CIS-GAY CIS- CIS- PEOPLE BISEXUAL MEN LESBIAN/ BISEXUAL PEOPLE BISEXUAL MEN LESBIAN/ BISEXUAL PEOPLE BISEXUAL MEN LESBIAN/ BISEXUAL MEN GAY WOMEN MEN GAY WOMEN MEN GAY WOMEN WOMEN WOMEN WOMEN Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 4
• Overall, 20% of LGBT respondents reported that the police or state officials had been verbally abusive, and 11% reported physical abuse. Experiences of verbal and physical abuse by police were especially high for transgender people (29% and 24%, respectively). • 75% of LGBT respondents were bullied at least once before they turned 18 and 25% of LGBT respondents were fired from or denied a job in their lifetimes. Both experiences were more common among transgender and gay/bisexual male respondents. • Everyday experiences of discrimination, or microaggressions, were a common experience for LGBT respondents. Almost three-quarters of the respondents reported that people had acted as if they were better than them (73%) and reported that they were treated with less courtesy than others (70%). A significantly higher proportion of transgender respondents reported experiencing microaggressions than cisgender LGB respondents.
Community Connectedness • Generally, LGBT respondents felt a high affiliation with their LGBT community. Respondents agreed with statements saying they feel like they are a part of the LGBT community, are proud of the LGBT community, and have a bond with the LGBT community. Sixty-three percent felt that where they lived was a “good place” for LGB people to live; 43% felt where they lived was a “good place” for transgender people to live. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 5
INTRODUCTION
COLOMBIA AND THE RIGHTS OF LGBT PEOPLE Historically, lesbian, gay, bisexual, and transgender (LGBT) rights and protections have been challenged by conservatism, homophobia, gender violence, and opposition from the Church in Latin America (Oettler, 2019; Ardila, 2015; Corrales & Pecheny, 2010). Since the decriminalization of homosexuality in 1981, the rights of LGBT people in Colombia have advanced, making it one of the most progressive countries in Latin America in regards to the formal legal status of LGBT rights. Today, legal protections for sexual minorities include same-sex marriage, retirement pensions, Social Security, property rights, legal protection from discrimination on the basis of sexual orientation and gender identity, and the adoption of children by same-sex Colombia is located in the north of South America, couples. Colombia also protects the right of made up of 32 departments, with the capital Bogotá in the Capital District. Colombia is the individuals to change their name and gender third most populous country in Latin America identification (Lemaitre-Ripoll, 2009). Cali, the after Brazil and Mexico, with a population of third largest city in the country, is home to approximately 48,258,494 (National Administrative the first gender clinic that serves transgender Department of Statistics [DANE], 2019). Colombia children and adolescents (Fundación Sergio is a presidential republic. According to DANE Urrego, 2017). Various groups are involved statistics, 80% of Colombians are Roman Catholic in advocacy for LGBT people in Colombia and 17% Evangelical Christian, the remaining including Colombia Diversa, Red Trans 3% are Buddhist, Hindu, Jehovah’s Witnesses or Comunitaria in Bogotá and Cali, and Casa Agnostic. Colombia is ethnically and linguistically Diversa in Commune 8 of Medellín (Ardila, diverse and has a rich cultural heritage that reflects 2015). In October 2019, Claudia Lopez, the the influences of several Amerindian civilizations, leaser of Colombia's Green Alliance party won European settlements, forced labor of African slaves elections for the mayoralty of Bogota, maker and immigration from Europe and the Greater her the first woman and first lesbian mayor of Middle East since the early twentieth century. Colombia has the second largest biodiversity in the Colombia's capital city. world and is one of the 17 mega-diverse countries in the world (Colombia.com, 2019; Oficina de VIOLENCE AGAINST LGBT Información Diplomática del Ministerio de Asuntos PEOPLE IN COLOMBIA Exteriores y de Cooperación, 2017). A decades-long conflict between government forces, paramilitaries, Despite the peace process and the general and antigovernment insurgent groups heavily funded reduction of homicides nationwide, violence by the drug trade, principally the Revolutionary against LGBT people in Colombia persists. Armed Forces of Colombia (FARC), escalated Moreover, although LGBT rights have been during the 1990s. After four years of formal peace recognized and there have been multiple negotiations, the Colombian Government signed a judgments issued by the Colombian final peace accord with the FARC in November 2016, Constitutional Court, as well as various laws which was subsequently ratified by the Colombian issued by the Congress of the Republic, and Congress. The accord called for members of the FARC decrees that protect the rights of the LGBT to demobilize, disarm, and reincorporate into society population issued by the Colombian Executive and politics (The World Factbook, n.d.). Branch, LGBT people still suffer considerable discrimination and violence (Colombia Diversa and Caribe Afirmativo, 2018). Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 6
According to the National Victims’ Registry, violence against LGBT people include homicide, torture, displacement, threats, crimes against freedom and sexual integrity, terrorist acts, harassment, kidnapping and other acts of violence. The National Victims’ Registry reported 109 deaths in 2017. Of them, 44 were gay men (40%), 36 were transgender women (33%), 5 were lesbians, 3 were transgender men, one was a bisexual man, and 20 (18%) were LGBT but not specified in the report. The average age of the dead was 37 years, with transgender victims younger than the LGB victims. Most of the deaths reported in 2017 (97 of 109) occurred in metropolitan areas of the departments of Valle del Cauca (Cali), Tolima (Ibagué), Antioquia (Medellín), Atlántico (Barranquilla and Soledad), Bogotá, DC, Bolívar (Cartagena) and Norte de Santander (Cúcuta). Of the 109 deaths, 12 occurred in rural areas in the departments of Antioquia, Valle del Cauca, Huila, Nariño, Tolima and Santander. Most of the victims were engaged in poorly paid work and with high exposure to violence, such as vehicle drivers, stylists, and waitresses, and in the underground economy, such as recyclers, street vendors, and sex workers. Only six of the victims worked in technical or professional activities, and only one was a university student (Colombia Diversa and Caribe Afirmativo, 2018).
LGBT activists and advocates are at risk for violence as well. In 2017, 60 activists reported having been threatened individually and collectively and six activists were killed. Most of these acts were carried out by criminal gangs and paramilitary groups through flyers, telephone calls, social networks, and direct intimidation (Colombia Diversa and Caribe Afirmativo, 2018).
Violence against LGBT people perpetrated by armed groups
Historically, the LGBT population has been discriminated against and suffered violence by armed groups. Violence against LGBT people is part of the strategies of social and territorial control of the armed groups that impose behavioral norms and act as administrators of justice, subjecting LGBT people to a social policing by armed groups and the imposition of a unique moral order based on heterosexuality as the only socially approved path accepted by these groups, and strict adherence to traditional gender roles. LGBT people who breach this moral code were sanctioned or killed by groups operating outside the law. Thus, LGBT people have been subject to social exclusion, public humiliation, violence, prejudice, exile, and harassment by these groups. It is believed that many incidents of violence go unreported by the victims because of fear and distrust of governmental authorities (Colombia Diversa, 2017). LGBT people have been forced to get tested for HIV by armed groups, and those who were HIV positive have been forced to leave their homes (Colombia Diversa, 2017).
Police violence against LGBT people
Police violence has become a form of de facto criminalization of the most vulnerable and excluded LGBT people in Colombia, and coercive measures are applied in an unjustified and arbitrary manner. Most of the LGBT victims of police violence are young, with low employment and education.
According to the Information System on Violence against LGBT Persons in Colombia (2018) in 2017, 66 acts of police violence against LGBT persons were recorded in 17 departments of Colombia, and 26% of the cases were motivated by the police officers’ prejudice towards the gender identity and sexual orientation of the victims. The greatest number of cases occurred in Antioquia and Bogotá, followed by Valle del Cauca, Quindío, and Huila. These 66 acts of police violence affected approximately 75 LGBT people. The majority were transgender and bisexual and lesbian women with Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 7
an average age of 24 years and low levels of education. They worked low-paying jobs such as sex work and housekeeping. Police violence occurred in public spaces and in the homes of the LGBT victims. Police have also targeted same-sex couples and groups of LGBT people. In 2017, 12% of the 66 cases of police violence were recorded as acts of violence or discrimination against same-sex couples (Colombia Diversa, Caribe Afirmativo and Santamaría Fundación, 2018).
Acts of police violence prevent LGBT people from fully participating in the cultural and political life of their country. For example, in Bogotá, there have been cases of LGBT people being harassed by police while participating in political protests (Colombia Diversa, Caribe Afirmativo, and Santamaría Fundación, 2018).
YOUTH IN SCHOOL The LGBT School Environment Survey, conducted in 2015 and 2016 in Colombia, showed that Colombian LGBT students reported feeling unsafe in their schools due to their sexual orientation (67%) and insecure about their gender expression (55%). A majority of youth (76%) heard homophobic expressions at school during the school year. More than a third (36%) reported avoiding using the restrooms; 23% avoided attending physical education classes; and 15% of LGBT students avoided being at school after class due to fear. 23% of youth avoided going to classes for fear of bullying, which affected their academic performance. Many LGBT students (84%) have been the victims of verbal harassment, physical harassment (43%), and sexual harassment (47%). Almost half (44%) of LGBT students reported that they had suffered theft or damage of their personal property by other students and a third (34%) were victims of cyberbullying. Rather than protecting LGBT students, 37% of students reported being assaulted by a teacher because of their sexual orientation or gender identity. 25% of students were themselves, or knew other students who were, penalized for something related to being LGBT (Sentiido & Colombia Diversa, 2016).
HEALTH OF LGBT PEOPLE A study by Pineda-Roa and Navarro-Segura (2019) on stressful life events in the Colombian LGBT population, reported that 2 of 3 participants perceived some level of stress due to their sexual orientation. Stress in women was related to their relationships with parents and other relatives. For men, stress was associated with problems with the police and with being physically assaulted in an incident or attack. Young adults aged 18–29, experienced higher levels of stressful events than adults over 30.
Data on stress and health of LGBT people is scarce. We know of no national data on LGBT people’s health, and we could not find research publications that provide good estimates on the health of the LGBT population. The literature review below summarizes what is currently known about the health of LGBT people in Colombia.
A Bogotá study found that the stressor that most impacted LGBT people was fear of losing a job due to discrimination. Despite finding that 88% of LGBT people surveyed reported good health, 46% reported worry and fear, 54% reported tiredness and exhaustion, 49% reported feeling irritable, 48% reported sleep problems, and 41% reported headaches and muscle tension over the year prior to survey (Jiménez-Castaño, Cardona-Acevedo, & Sánchez-Muñoz, 2017). These findings suggest Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 8
disparities with the general Colombian population. Compared with LGBT people, Colombian general population present with less sleep problems (31%, Ruíz, Sepulveda, Martínez, Muñoz, Mendoza, Centanaro, 2016); lower prevalence of mood disorders (15%, Ministry of Social Protection and Foundation, 2005) and lower prevalence of headaches (3%–9%, Zapata , 2019).
A 2008 study by the Mayor’s Office of Bogotá determined that the health system was not responsive to the health needs of LGBT people due to stigmatization. The study noted that LGBT patients who were open about their sexual orientation and gender identity to their healthcare providers were more likely to be discriminated against in medical services and care. The report noted a dearth of culturally sensitive healthcare training for personnel providing services to LGBT people (Alcaldia Mayor de Bogota, Secretaria Distrital de Planeacion, 2008).
HIV/AIDS
Colombia ranks second among Latin American countries in HIV prevalence, affecting about 1% of the adult population (Joint United Nations Programme on HIV/AIDS, 2013). A study conducted in 2011 in Bogotá suggested that the prevalence of HIV infection among men who have sex with men was 12%. Among HIV-positive participants, only 40% were aware of their serostatus. HIV-positive–unaware individuals were more likely than other participants to report inadequate insurance coverage, substance use, and engaging in sex in exchange for money, goods, or services (Zea, 2015).
The Colombian Ministry of Health and Social Protection indicated that there were 150,116 reported cases of HIV by 2016. The prevalence of HIV infection rates showed an increase in gay/bisexual men from 12% of the HIV positive population in 2010 to 17% in 2016 and the proportion of transgender women went from15% in 2012 to 21% in 2016 (Ministerio de Salud y Protección social, 2018a).
The report also noted that 14% of gay/bisexual men with HIV and 31% of transgender women with HIV did not have health insurance (Ministerio de Salud y Protección social, 2018a). This represents a disparity with the general Colombian population where only 6% do not have health insurance (Ministerio de Salud y Protección social, 2018b).
Alcohol and drugs
Barreto, Sandoval and Cortés’s (2010) study in Bogotá found that gay men allocate more money to alcohol consumption than all other groups, spending an average of 116,947 Colombian Pesos (US$62) per month, followed by bisexual men, transgender people, bisexual women, and lesbians. Heterosexuals spent on average 34% less money than gay men. Another study with a sample of 175 gay men between the ages of 14 and 27 in Bogotá, showed that 36% reported consumption of one or more drugs. The study also found an association between young age and greater risk for drug use and that gay/bisexual men who drink alcohol have three times the risk of using one or more drugs (Pineda, 2015). Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 9
Suicide
It appears that no research on suicide in Colombian LGBT populations has been published (Pineda- Roa, 2019). The first paper, published in 2019 by Pineda-Roa, assessed risk factors of suicidal ideation in a sample of gay/bisexual adolescents (14–17 years old) and young adults (18–27 years old) in Bogotá. No study examined suicide in the transgender population. Pineda-Roa found that 30% of the men reported suicidal ideation. Factors associated with suicidal ideation included age, internalized homophobia, and a history of sexual abuse (Pineda-Roa, 2019). Despite the high prevalence of suicidal ideation, Legal Institute of Legal Medicine and Forensic Sciences of Colombia reported only nine cases of death due to suicide in LGBT people in 2017. In 2018, the Institute reported 2,458 cases of suicide in all of Colombia. Of these cases, 0.5% (13) were LGBT people (10 men; 3 women). Difficulties of assessing LGBT suicide in post mortem assessment are well documented, indicating that the low prevalence of recorded LGBT deaths by suicide are a gross underestimation of the true prevalence (Haas & Lane, 2015).
AIMS OF THIS STUDY Colombia is a country of contradictions when it comes to LGBT lives. On one hand, there are impressive gains in civil rights protections to LGBT people, but on the other hand, there continues to be serious violence perpetrated against LGBT people, especially gay/bisexual men and transgender women. Also, despite progress in the status of LGBT people, in Colombia, like other countries, there are risks of retraction of achieved rights. As Mauricio Albarracin, an LGBT rights activist, said, “We have marriage equality and other rights, but now we need to protect them because the conservative movement is strong and is very well connected to the presidency” (Moloney, 2018).
Although we are aware of data on violence experienced by LGBT people in Colombia, including some statistics described above, we are not aware of any information on exposure to stressors other than violence, e.g., discrimination and rejection, or even basic statistics on the health and well-being of LGBT people in Colombia. There seem to be no national data on LGBT people’s health, and we could not find research publications that provide estimates on the health of the LGBT population.
With this background in mind, we set up to study Colombia LGBT people’s stress, health, and well- being. The study aimed to provide a broad picture about LGBT people in Colombia in these areas: (a) demographic characteristics, including socioeconomic status, familial relationships, religion, geographical region; (b) experiences of stress, discrimination, and violence; (c) health and well-being, including psychological distress (e.g., depressive symptoms), drug use, alcohol use, and suicidality; and (c) connection with the LGBT community.
In this study, we use a minority stress perspective to research Colombian LGBT people (Institute of Medicine, 2011). The minority stress perspective suggests that stigma and prejudice toward LGBT people create a social environment that predisposes them to experience stress related to prejudice, in turn, this stress leads to adverse health outcomes and disparities in health between LGBT and cisgender straight populations. (Meyer, 2003). The minority stress perspective refers to both interpersonal and institutional stressors. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 10
Examples of interpersonal stressors include being called derogatory names by an individual, being assaulted, or being discriminated against. Examples of institutional stress include discriminatory policies, laws that do not protect LGBT people, and general social conditions and attitudes that are hostile to LGBT people.
Minority stress describes specific stress processes that stem from prejudice (homophobia and transphobia). The specific stress processes include life events, such as prejudice events like the experience of violence and discrimination, as well as stressors that stem from the internalization of social conventions, such as prevailing antigay (homophobic) or transphobic stereotypes and ideology.
Hate crimes are a particularly painful type of prejudice event because they inflict not only the pain of the assault itself, but also the pain associated with the social disapproval of the victim’s stigmatized social group. The added pain is associated with a symbolic message to the victim that he or she and his or her kind are devalued, debased, and dehumanized in society. Such victimization affects the victim’s mental health because it damages his or her sense of justice and order (Frost, Lehavot, & Meyer, 2013). It is not only the pain of the assault, but the pain reverberated through the act of the entire community’s disapproval, derision, and disdain. Prejudice events may be perpetrated by one perpetrator, but it is the message of hate of a larger community that makes hate crimes especially painful.
Even seemingly low-magnitude “everyday discrimination” occurrences can have a great impact because of the symbolic message of social disapproval reflected in such occurrences. Such experiences do not qualify as major life events because they are seemingly minor by any objective measure. In stress terms, these incidents bring about little objective change and, therefore, require less adaptation than what would be required by major events, such as finding a new job after losing one’s job. Nonetheless, these and similar everyday discrimination instances can be damaging even if they are not major events because of the symbolic message of rejection that they convey.
Minority stress also describes proximal stress processes. These are stressors that act through the internalization, by the LGBT person, of anti-LGBT (i.e., homophobic and transphobic) social attitudes. For example, LGBT people, like all people in society, are socialized to learn negative views of sexual and gender minorities. As LGBT people identify as such, they must learn to overcome such homophobic and transphobic attitude in a process that some call “coming out” where they repair negative self-views and develop more affirmative and positive images of what it is like to be LGBT. Minority stress further describes the role of social support and the availability of community resources in helping LGBT people gain such positive self-regard. But to the extent that LGBT people retain homophobic and transphobic attitudes, these can be directed toward the self and have a negative impact on health, for example, exacerbating drug and alcohol use and disturbing the development of positive intimate relationships (Frost & Meyer, 2009).
Research on minority stress in transgender people has shown how minority stressors impact the health of transgender and gender non-conforming individuals (Testa, Habarth, Peta, Balsam, & Bockting, 2015; Hendricks & Testa, 2012). These writings suggest that similar minority stressors are applicable to gender minorities as has been described for sexual minorities. A unique source of stress concerns gender non-affirmation of transgender or gender non-conforming individuals in Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 11
formal and informal social interactions (Sevelius, 2013; Testa, Habarth, Peta, Balsam, & Bockting, 2015). Gender affirmation refers to the respect and affirmation of an individuals’ gender identity regardless of perceived transgressions of gender roles and expectations. the experience that society and individuals in both formal and informal interactions respect and affirm one’s gender identity regardless of perceived transgressions of gender roles and expectations. For example, a person who was assigned male at birth but identifies and presents as female may find hostility because of social expectations that she adheres to her male sex as assigned at birth. Such a person may experience stress from both informal sources—family, friends, and strangers in daily interactions—and in formal transactions—such as not having an identity card or other identifying documents that display her gender as she identifies it and as she presents in attire and mannerism. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 12
METHODS
SAMPLE We used multiple recruitment methods aimed at getting a sample of LGBT people who reside in Colombia that is diverse in sexual orientation, gender, gender identity, geographic residence, and socioeconomic status. Sampling was accomplished by solicitation through social media (Instagram, Facebook) and in-person interactions in general (e.g., Barranquilla carnival) and at LGBT-specific venues (e.g., gay bars). Recruitment lasted about 5 months between February 17, 2019 and July 10, 2019. We used a team of recruiters as well as a few Instagram influencers who were committed to publicizing the study. All study recruitment used variations of an advertisement shown in Figure 1, which includes a short request for LGBT people to share their experiences in the survey and the QR code or url linking to the Qualtrics self-administered survey.
In-person recruitment sites included major events in Colombian cities like the LGBT Guacherna parade, (which takes place the week before the main Barranquilla carnival), the LGBT Guacherna in Soledad; Santo Tomas Carnival; Coronation of the king of the Carnival in Soledad; Cartagena Pride Festival, the Besaton in Bogotá; IX LGBTI Bogotá Pride and IX LGBTI Barranquilla and the Atlántico. Recruitment in LGBT venues included discos and bars in Barranquilla, Soledad and Cartagena, and places where LGBT people go, such as barbershops, hairdressers, and restaurants. We also recruited in universities (Universidad de la Costa and Universidad Simón Bolívar, Universidad del Norte, all of them in Barranquilla), and LGBT organizations.
Online and social media recruitment included social network apps (e.g., Facebook, Instagram, Twitter, Tinder, and Grindr). Campaigns and giveaways were made inviting LGBT people to participate on the project and to fill the survey. We also used LGBT influencers with large following in Colombia to disseminate the survey advertisements and QR codes.
To increase the visibility of the study, Dr. Meyer and Ms. Flórez presented information about the study at local and national outlets including Colombia National Psychology Association in Bogotá (Colombian College of Psychologists, COLPSIC) and the Universidad de la Costa in Barranquilla. National and local media covered stories or mentions of the study in newspapers, national and local television news, web portals, blogs, radio stations, and online radios. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 13
Figure 1. Recruitment flyer for Colombia LGBT study
Upon following the link or using the QR code, respondents were directed to a screen to assess their eligibility to participate in the study. Respondents were eligible if they identified as lesbian, gay, bisexual, and/or transgender, resided in Colombia, and had education of more than 4th grade (to ensure they comprehend and are able to complete the self-administered questionnaires). Respondents who were not eligible were thanked for their participation after they completed the screen. Eligible respondents continued to the survey questionnaire. Because the survey was complex, taking 20–40 minutes to complete, respondents were able to take a break and continue responding the questionnaire any time during a 48 hours period after initiating the survey. After 48 hours the survey link became unavailable to the IP address that initiated the survey. To guard against multiple entries from any respondents, only one entry was allowed per IP address.
By July 10, 2019, when the survey site was closed, 7,410 individuals (6,129 cisgender, 303 transgender, and 435 gender non-binary) responded to at least some of the screen questions. Of them, 5,304 respondents were eligible and continued to answer the survey questionnaire; of those eligible, 437 respondents had more than 90% responses missing and they were eliminated from the sample, resulting in a final sample of 4,867 people including 1,243 cisgender and gender non-binary lesbian/ gay women, 895 cisgender and gender non-binary bisexual women, 2,163 cisgender and gender non- binary gay men, 334 cisgender and gender non-binary bisexual men and 232 transgender people. Altogether there were 307 gender non-binary respondents.
The study protocol was approved by the Institutional Review Board (IRB) of UCLA in the United States and the IRB of the Ser Feliz is Free International Foundation in Colombia. Respondents received an information sheet. No signed consent forms were collected. Because the survey was anonymous, the IRB determined that collecting signed consents would unnecessarily increase the risk for loss of confidentiality as a consent form would have been the only document with identifying information about the survey respondents.
Incentives. Some respondents, when recruited in person at a venue, received a promotional gift (e.g., a wrist band) in an effort to promote the study. Incentives were not conditioned to actual participation in the study. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 14
QUESTIONNAIRE The questionnaire was translated into Spanish from English and then translated back into English. Inconsistencies between the original and English translation were reviewed and assessed for accurate translation by the study investigators with the aid of a translation service (SimulTrans, LLC). The questionnaire’s items and sources can be found in Appendices 3 and 4.
DATA PREPARATION AND STATISTICAL ANALYSIS
Data coding
Several variables (e.g. victimization questions, see Table 5) were collapsed from an ordinal (e.g. never, one time, 2 times, 3 or more times) to a dichotomous (never vs. ever) response pattern. Low-response categories (e.g. religions with fewer followers) were occasionally consolidated into single categories. Text responses (e.g. location of residence, age of coming out) were consolidated into a smaller number of categories, each coded by a numerical value. Impossible response values (e.g. age less than zero or greater than 120) were converted to missing. Scales scores, such as the Kessler 6 and DUDIT, were generated according to published guidelines for these scales (see below).
Data imputation
Because of the sensitive nature of some questions, which respondents were allowed to skip, and because of the burden on respondents due to the relatively lengthy questionnaire, we expected a high number of missing values. In the presence of missing data, estimation using only complete cases may be biased unless the data are missing completely at random, such that the missingness is not related to any observed or unobserved variables. One common strategy employed for unbiased estimation with missing data is multiple imputation, which creates multiple datasets in which the missing data are replaced with values that are randomly and independently drawn from a distribution of imputed values. This distribution of imputed values for any single variable is generated by an imputation model using variables that can help predict the missing values. For estimation with multiply imputed data, the model is fit to each imputed dataset, and the results are averaged according to Rubin’s rules (Rubin, 1987) to produce multiply imputed estimates. Estimates derived from multiply imputed data have been shown to be less biased than those estimated with complete cases with as much as 90% missing (Madley-Dowd et al., 2019).
In our sample, 437 respondents had more than 90% responses missing, and they were eliminated from the sample because imputation was not deemed appropriate per research in this area. Respondents with 90% or more missing completed the screen questions that determined their eligibility to participate in the study, but then never completed the entire survey either forgetting to come back to the survey within the allowable timeframe or, in effect, refusing to participate. Missing data were imputed using the chained equations method, where a set of variables are imputed individually and sequentially, allowing completed variables to serve as predictors of incomplete variables (van Buuren, 2007). Continuous and ordinal variables were imputed with predictive mean matching; binary variables were imputed with logistic regression models, and nominal variables with multinomial logistic regression models. Complete variables coding for sex at birth, education level, and employment were added as predictors to imputation models for all variables. Scale scores were Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 15
directly imputed with relevant individual scale items included in the imputation model.
Missing values for variables that were only asked of certain subpopulations (e.g. only transgender respondents) were imputed using models restricted to those subpopulations. We imputed missing values in 50 modeled data sets.
Two variables, “gender of partner” and “religion” could not be imputed properly due to low observed frequencies in some of the rare response categories (e.g., Muslim religion). For these variables, estimates based on a single imputed dataset are reported instead.
Sexual orientation and gender identity acronyms and how they were used in analysis
LGBT: People who identify as lesbian, gay, bisexual, and transgender people. Transgender: People who identify as transgender or whose current gender identity differs from their sex assigned at birth, regardless of their sexual orientations. Cisgender: People whose current gender identity is the same as their sex assigned at birth.
We report results about LGBT people together as a group but also separately report about cisgender and gender non-binary gay and bisexual men, cisgender and gender non-binary lesbian, gay, and bisexual women, and transgender men and women. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 16
FINDINGS
DEMOGRAPHIC CHARACTERISTICS OF LESBIAN AND BISEXUAL WOMEN, GAY AND BISEXUAL MEN, AND TRANSGENDER SURVEY RESPONDENTS IN COLOMBIA
Geographic distribution of respondents
Figure 2. Distribution of participants across Colombia
1,142 NUMBER OF RESPONDENTS 10 0 1-100 SAN ANDRÉS Y 101-500 70 PROVIDENCIA 5 501-1,000 39 1,001-1,500 16 1,500 +
256 29 43
2 592 SANTANDER 113 6
40 CALDAS CUNDIN- 10 47 AMARCA 32 RISARALDA 63 QUINDÍO 0 38 VALLE DEL CAUCA 58 268 46
43 0
37 1 18
3 0 8
1
BOGOTÁ, D.C 1,618 Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 17
Demographic characteristics of survey respondents
LGB respondents
The majority of the sample (76%) were between the ages of 18 to 29, about 20% were aged 30 to 50, and 5% of the sample was aged 50 and older. Among women, a greater proportion of bisexual women (87%) were younger than their lesbian/gay counterparts (66%), and among men, a greater proportion of bisexual men (83%) were younger than gay men (77%) (Table 1). A slight majority (54%) of the respondents were assigned male sex at birth. The large minority of the sample had a college level education (44%). Lesbian/gay women did not differ significantly from bisexual women in having a college-level education. However, more lesbian/gay (10%) respondents had a graduate school-level education than bisexual women (7%). There was not a significant difference in having a college-level education or higher between male and female respondents or between the male gay and bisexual respondents. More than a quarter of the LGB people (27%) were unemployed with a somewhat greater proportion of lesbian/gay participants (29%) than bisexuals (23%) unemployed. Unemployment was not significantly different between gay/bisexual men and LGB women over all.
In terms of marital status, most LGB people (78%) reported being single. However, group differences showed that more bisexual women (79%) were single than lesbian/gay women (67%), whereas the proportion of single gay men (83%) was not significantly different than bisexual men (83%). Overall, a large minority (44%) of LGB respondents had a partner and there was no difference between lesbian/ gay and bisexual women and between gay and bisexual men, but fewer men (34% gay; 33% bisexual men) had a partner than women (60% lesbian/gay; 50% bisexual women). Of those who had a partner, a greater proportion of lesbian/gay women (95.1%) had a female partner than bisexual women (66.6%), and a greater proportion of gay men (98.6%) had a male partner than bisexual men (78.5%).
Only a small proportion of the sample (5%) had children. Lesbian/gay women (8.4%) did not differ significantly from bisexual women (6%), but fewer gay men (1%) had children than bisexual men (7%).
The largest proportion of the sample (37%) had a socioeconomic status level of 3 in the range of 1–6 Colombian social strata1 classification; 26% of respondents had a socioeconomic status level of 2 and only 2% reported having the highest socioeconomic status (level 6). Lesbian/gay and bisexual women and gay and bisexual men did not differ significantly in social class. The difference between men and women was also not statistically significant.
In terms of personal income, 44% of the sample reported a personal income lower than COL$781,242 per month (about US$260), the minimum monthly salary in 2017 in Colombia. Fewer lesbian/gay women (38%) than bisexual women (56%) had a personal income less than COL$781,242. Similarly, a smaller proportion of gay men (41%) than bisexual men (52%) fell into the lowest income bracket. The difference between men and women was not statistically significant.
1 The socio-economic stratification system in Colombia classifies urban populations into different strata according to economic characteristics. Strata ranges from 1–6, with 1 as the lowest income area and 6 as the highest. The purpose of the system is primarily to grant subsidies to the poorest residents, as those with more economic capacity (stata 5 and 6) pay more for public services (e.g., water, sewage), offsetting the cost to those in strata 1, 2, and 3. The system has established a well-known social divide often associated with stigma. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 18
In terms of religion, the largest proportion (49%) of the sample reported no formal religion, being atheist, agnostic, spiritual, or non-religious, followed by 41% who said they were Catholic. Among women, a larger proportion of bisexual women than lesbian/gay women had no formal religion, (57% v. 45%). There was no difference in religious affiliation between gay and bisexual men. More lesbian/ gay women than bisexual women were Catholic (46% v. 35%). There was no difference in being Catholic between gay and bisexual men and no difference between women and men.
Transgender respondents
Significantly more transgender respondents (20%) were older than age 50 than the LGB respondents. Of the transgender respondents 66% were assigned male at birth.
In terms of education, a smaller proportion of transgender respondents (25%) had a college-level education than LGB respondents and a larger proportion of transgender respondents (44%) were unemployed compared to LGB respondents.
In terms of marital status, the majority of transgender respondents (79%) were single, however, 38% of transgender respondents had a partner. Among those who had a partner, 55% of had a male partner and 38% had a female partner. Among the transgender respondents, 5% had children. Significantly more transgender respondents (25%) were at the lowest economic status (level 1), compared to lesbian/gay women (8%), bisexual women (9%), gay men (13%) and bisexual men (13%) and 50% of transgender respondents reported a personal income of less than COL$781,242 (about US$260), the monthly minimum wage.
In terms of religion, 43% of transgender respondents reported they were atheist, agnostic, spiritual or non-religious, which did not differ significantly from LGB respondents. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 19
Table 1. Demographic characteristics of LGBT participants in the 2019 experiences of LGBT people in Colombia survey (N=4,867), proportions and confidence intervals
TOTAL SAMPLE WOMEN (N= 2,138) MEN (N =2,497) TRANSGENDER VARIABLE (N = 4,867) LESBIAN/GAY BISEXUAL GAY BISEXUAL (N = 232) % [95% CI] % [95% CI] % [95% CI] % [95% CI] % [95% CI] % [95% CI] Age 18 - 29 75.6% [74.4, 76.8] 65.7% [63.1, 68.4] 86.8% [84.5, 89.0] 76.7% [74.9, 78.5] 83.2% [79.2, 87.3] 63.4% [57.1, 69.6] 30 - 49 19.3% [18.2, 20.4] 29.6% [27.0, 32.1] 10.9% [8.8, 12.9] 18.2% [16.5, 19.8] 12.6% [9.0, 16.1] 16.8% [12.0, 21.7] 50 and older 5.1% [4.5, 5.8] 4.7% [3.5, 5.9] 2.4% [1.4, 3.3] 5.1% [4.2, 6.0] 4.2% [2.0, 6.4] 19.8% [14.7, 25.0] Sex assigned at birth Female 45.5% [44.1, 46.9] 100% -- 100% ------33.6% [27.5, 39.7] Male 54.5% [53.1, 55.9] -- -- 100% -- 100% -- 66.4% [60.3, 72.5] Education 5th grade 0.4% [0.2, 0.6] 0.1% [-0.1, 0.2] 0.1% [-0.1, 0.3] 0.4% [0.1, 0.6] 0.3% [-0.3, 0.9] 4.3% [1.7, 6.9] Secondary or high school 21.6% [20.5, 22.8] 17.3% [15.2, 19.4] 27.0% [24.1, 30.0] 20.3% [18.6, 22.0] 24.0% [19.4, 28.6] 33.2% [27.1, 39.3] Technical school 24.3% [23.1, 25.6] 25.3% [22.8, 27.7] 19.3% [16.7, 21.9] 25.1% [23.2, 26.9] 23.1% [18.5, 27.6] 34.1% [27.9, 40.2] College 44.3% [42.9, 45.7] 46.9% [44.1, 49.7] 46.7% [43.4, 50.0] 43.7% [41.6, 45.8] 45.2% [39.8, 50.6] 25.0% [19.4, 30.6] Graduate school 9.3% [8.5, 10.1] 10.5% [8.8, 12.2] 6.8% [5.2, 8.5] 10.6% [9.3, 11.9] 7.5% [4.6, 10.3] 3.4% [1.1, 5.8] Employment
Full time 22.8% [21.6, 24.0] 25.7% [23.2, 28.1] 13.4% [11.2, 15.6] 26.2% [24.4, 28.1] 18.0% [13.8, 22.1] 18.5% [13.5, 23.6]
Part time 7.2% [6.4, 7.9] 7.5% [6.0, 8.9] 6.6% [5.0, 8.2] 7.2% [6.1, 8.3] 8.1% [5.1, 11.0] 6.0% [2.9, 9.1] Unemployed 27.3% [26.1, 28.6] 28.6% [26.1, 31.2] 22.6% [19.8, 25.3] 27.1% [25.2, 29.0] 25.4% [20.8, 30.1] 44.0% [37.5, 50.4] Homemaker 2.0% [1.6, 2.4] 2.6% [1.7, 3.5] 2.1% [1.2, 3.1] 1.6% [1.0, 2.1] 1.5% [0.2, 2.8] 3.9% [1.4, 6.4] Student 33.7% [32.3, 35.0] 26.9% [24.4, 29.3] 46.1% [42.9, 49.4] 32.0% [30.1, 34.0] 40.4% [35.1, 45.7] 27.6% [21.8, 33.4] Retired 0.8% [0.5, 1.0] 0.8% [0.3, 1.3] 0.2% [-0.1, 0.5] 0.8% [0.4, 1.2] 1.2% [0.0, 2.4] 2.2% [0.3, 4.0]
Unable to work due to 0.3% [0.2, 0.5] 0.2% [-0.0, 0.5] 0.4% [0.0, 0.9] 0.3% [0.1, 0.5] 0.6% [-0.2, 1.4] 0.4% [-0.4, 1.3] disability Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 20
TOTAL SAMPLE WOMEN (N= 2,138) MEN (N =2,497) TRANSGENDER VARIABLE (N = 4,867) LESBIAN/GAY BISEXUAL GAY BISEXUAL (N = 232) % [95% CI] % [95% CI] % [95% CI] % [95% CI] % [95% CI] % [95% CI] Marital Status Single 78.1% [76.8, 79.5] 67.3% [64.6, 69.8] 79.0% [76.2, 81.5] 83.5% [81.7, 85.3] 83.8% [79.5, 87.4] 79.4% [73.8, 85.1] Married 2.4% [1.9, 2.9] 1.9% [1.3, 2.9] 2.0% [1.3, 3.2] 2.6% [1.8, 3.3] 3.3% [1.8, 5.9] 1.7% [-0.2, 3.6] Common-law 1.2% [0.8, 1.6] 1.7% [1.1, 2.6] 1.0% [0.5,1.9] 0.5% [0.1, 0.8] 3.3% [1.8, 5.9] 2.0% [0.1, 3.9] Divorced/Separated 0.1% [-0.1, 0.3] 23.7% [21.4, 26.1] 13.2% [11.1, 15.6] 0.2% [-0.1, 0.4] 6.3% [4.1, 9.5] 0.7% [-0.7, 2.0] Widowed 14.1% [13.0, 15.3] 5.5% [4.3, 6.9] 4.8% [3.6, 6.4] 10.3% [8.8, 11.8] 3.3% [1.8, 5.9] 12.1% [7.4, 16.7] Other 4.0% [3.3, 4.6] -- -- 3.0% [2.2, 3.9] -- 4.1% [1.3, 6.9] Has a partner 43.7% [42.1, 45.3] 59.7% [56.6, 62.7] 49.7% [46.0, 53.3] 34.1% [31.8, 36.4] 33.4% [27.7, 39.1] 38.7% [31.9, 45.6] Gender of partner Man 48.8% [46.4, 51.1] 4.1% [2.9, 5.8] 31.7% [27.0, 36.4] 98.6% [97.5, 99.3] 78.5% [69.6, 85.4] 55.8% [44.4, 67.1] Woman 50.5% [48.1, 52.8] 95.1% [93.2, 96.4] 66.6% [61.9, 71.4] 1.2% [0.6, 2.3] 20.6% [13.8, 29.4] 38.4% [27.3, 49.6] Transgender 0.8% [0.3, 1.2] 0.8% [0.4, 1.8] 1.7% [0.3, 3.0] 0.1% [0.0, 1.0] 0.9% [0.1, 6.5] 5.8% [0.7, 10.9] Has children 4.7% [3.9, 5.5] 8.4% [6.5, 10.2] 6.5% [4.5, 8.4] 1.5% [0.9, 2.1] 6.7% [3.9, 9.6] 5.3% [2.2, 8.4] Socioeconomic status 1 11.5% [10.4, 12.6] 8.2% [6.5, 9.9] 9.0% [6.9, 11.2] 12.8% [11.2, 14.3] 13.5% [9.5, 17.6] 24.6% [18.7, 30.4] 2 26.1% [24.7, 27.6] 24.5% [21.8, 27.3] 26.6% [23.4, 29.9] 26.3% [24.2, 28.4] 26.1% [20.9, 31.3] 31.3% [24.9, 37.6] 3 37.3% [35.7, 38.8] 40.6% [37.6, 43.6] 38.1% [34.5, 41.6] 35.8% [33.5, 38.2] 38.3% [32.5, 44.1] 27.9% [21.8, 34.1] 4 17.3% [16.0, 18.6] 19.4% [16.8, 22.0] 18.3% [15.4, 21.2] 16.9% [15.1, 18.6] 13.7% [9.3, 18.0] 10.7% [6.3, 15.1] 5 5.5% [4.8, 6.2] 4.9% [3.4, 6.3] 6.2% [4.4, 8.0] 5.7% [4.6, 6.8] 5.9% [3.1, 8.6] 3.9% [1.2, 6.6] 6 2.3% [1.9, 2.8] 2.4% [1.4, 3.4] 1.8% [0.8, 2.7] 2.6% [1.8, 3.3] 2.6% [0.8, 4.4] 1.7% [-0.2, 3.5] Income (personal) Less than $781,242 44.4% [42.6, 46.2] 38.2% [34.9, 41.5] 56.5% [52.7, 60.3] 41.1% [38.6, 43.6] 51.6% [45.6, 57.6] 50.2% [43.2, 57.2] Between $781,242 and 22.2% [20.9, 23.6] 23.9% [21.2, 26.6] 19.3% [16.3, 22.2] 22.0% [20.0, 24.0] 21.3% [16.5, 26.0] 27.8% [21.5, 34.1] $999,999 Between $1,000,000 and 27.6% [26.1, 29.2] 31.6% [28.6, 34.6] 20.3% [17.1, 23.5] 30.5% [28.2, 32.7] 20.9% [15.9, 25.8] 17.8% [12.4, 23.3] $3,999,999 Between $4,000,000 and 3.8% [3.2, 4.4] 4.5% [3.3, 5.8] 2.3% [1.2, 3.4] 4.2% [3.3, 5.1] 4.1% [1.9, 6.4] 2.6% [0.4, 4.9] $6,999,999 More than $7,000,000 1.9% [1.5, 2.4] 1.7% [0.9, 2.5] 1.6% [0.7, 2.5] 2.2% [1.6, 2.9] 2.1% [0.4, 3.8] 1.6% [-0.2, 3.3] Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 21
TOTAL SAMPLE WOMEN (N= 2,138) MEN (N =2,497) TRANSGENDER VARIABLE (N = 4,867) LESBIAN/GAY BISEXUAL GAY BISEXUAL (N = 232) % [95% CI] % [95% CI] % [95% CI] % [95% CI] % [95% CI] % [95% CI] Religiosity Catholic 41.1% [39.5, 42.8] 46.3% [43.5, 49.0] 34.9% [31.8, 38.0] 42.3% [40.0, 44.7] 37.7% [32.7, 43.1] 43.5% [37.2, 50.0] Protestant/Christian 2.3% [1.8, 2.8] 2.5% [1.8, 3.5] 1.6% [0.9, 2.6] 2.5% [1.7, 3.2] 3.0% [1.6, 5.5] 3.0% [1.4, 6.2] Evangelical 3.4% [2.8, 4.0] 2.7% [2.0, 3.8] 3.0% [2.1,4.4] 3.4% [2.5, 4.3] 5.7% [3.6, 8.8] 4.3% [2.3, 7.9] Jehovah’s Witness 0.3% [-0.4, 1.0] 0.2% [0.0, 0.6] 0.0% -- 0.4% [-0.4, 1.3] 0.0% -- 1.3% [0.4, 4.0] Mormon 0.3% [0.1, 0.5] 0.1% [0.0, 0.6] 0.4% [0.2, 1.2] 0.3% [0.0, 0.6] 0.6% [0.1, 2.4] 0.0% -- Jewish 0.2% [-0.3, 0.7] 0.2% [0.0, 0.6] 0.1% [0.0, 0.8] 0.1% [-0.3, 0.6] 0.6% [0.1, 2.4] 0.0% -- Muslim 0.1% [-0.1, 0.4] 0.1% [0.0, 0.6] 0.0% -- 0.1% [-0.1, 0.4] 0.6% [0.1, 2.4] 0.0% -- Buddhist 0.3% [0.1, 0.5] 0.0% -- 0.0% -- 0.5% [0.2, 0.9] 0.0% -- 0.4% [0.1, 3.0] Other (Hare Krishna/ and 2.9% [2.4, 3.5] 2.9% [2.1, 4.0] 2.9% [2.0, 4.2] 2.6% [1.8, 3.4] 2.4% [1.2, 4.7] 4.3% [2.3, 7.9] everything else) Atheist/Agnostic/ 49.0% [47.2, 50.8] 45.1% [42.4, 47.9] 57.1% [53.8, 60.3] 47.7% [45.2, 50.2] 49.4% [44.0, 54.8] 43.1% [36.8, 49.6] Spiritual/None
*Note: -- indicates Not Applicable Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 22
PHYSICAL HEALTH, MENTAL HEALTH, AND SUBSTANCE ABUSE OF LESBIAN/GAY AND BISEXUAL WOMEN, GAY AND BISEXUAL MEN, AND TRANSGENDER SURVEY RESPONDENTS IN COLOMBIA
Physical health outcomes of LGB respondents
As seen in Table 2, a greater proportion of lesbian/gay women (96%) than bisexual women (91%) reported that they were in good, very good, or excellent health, a generalized subjective measure of health status. There were no differences between gay and bisexual men or between male and female respondents in overall reported health status.
In this relatively young sample, sleep disorders (e.g., insomnia, sleep apnea) were the most frequently reported health problem (15%). More gay and bisexual men (3%) than lesbian/gay (1%) and bisexual women (0.8%) had ever been diagnosed with liver disease and a greater proportion of gay (8%) and bisexual men (4%) had been diagnosed with HIV/AIDS compared to lesbian/gay (0.2%) and bisexual women (0.4%). Similarly, significantly more gay (12%) and bisexual men (8%) than lesbian/gay (2%) and bisexual women (2%) had been diagnosed with another type of sexually transmitted infection.
Physical health outcomes of transgender respondents
Of transgender respondents, 91% reported good, very good, or excellent health, which was not significantly different from LGB respondents. Like their LGB counterparts, many transgender respondents (17%) reported a sleep disorder. Transgender respondents and did not differ from LGB respondents significantly on other health outcomes with the exception of hypertension, which 10% reported, possibly due to their older age overall. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 23
Table 2. Physical health outcomes
TOTAL SAMPLE WOMEN (N= 2,138) MEN (N = 2,497) TRANSGENDER VARIABLE (N = 4,867) (N = 232) LESBIAN/GAY BISEXUAL GAY BISEXUAL % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI General Health Good, Very Good, or 95.0% [94.4, 95.7] 96.0% [94.9, 97.1] 91.4% [89.5, 93.3] 96.4% [95.5, 97.2] 95.0% [92.5, 97.5] 91.6% [87.9, 95.2] Excellent Fair or Poor 5.0% [94.4, 95.7] 4.0% [2.9, 5.1] 8.6% [6.7, 10.5] 3.6% [2.8, 4.5] 5.0% [2.5, 7.5] 8.4% [4.8, 12.1] Physical Health Outcomes Hypertension 6.0% [5.3, 6.7] 5.3% [4.0, 6.7] 3.6% [2.3, 4.9] 6.5% [5.4, 7.6] 8.6% [5.5, 11.8] 10.2% [6.2, 14.1] Cardiovascular 4.5% [3.9, 5.1] 4.1% [2.9, 5.3] 5.8% [4.2, 7.3] 4.0% [3.1, 4.9] 4.7% [2.3, 7.2] 6.3% [3.1, 9.4] Diseases Asthma or 10.5% [9.6, 11.5] 11.0% [9.2, 12.8] 12.8% [10.4, 15.1] 9.6% [8.3, 11.0] 10.8% [7.2, 14.5] 7.5% [3.9, 11.0] COPD Cancer 0.8% [0.5, 1.1] 0.7% [0.1, 1.2] 0.6% [0.0, 1.2] 1.1% [0.6, 1.6] 0.6% [-0.4, 1.6] 0.5% [-0.5, 1.5] Diabetes 1.6% [1.2, 2.0] 1.4% [0.7, 2.2] 1.7% [0.8, 2.7] 1.5% [0.9, 2.0] 1.0% [-0.3, 2.2] 3.2% [0.9, 5.5] Prediabetes 4.3% [3.7, 4.9] 4.6% [3.4, 5.8] 6.0% [4.3, 7.6] 3.8% [2.9, 4.7] 4.5% [2.1, 6.9] 1.5% [-0.2, 3.2] Autoimmune 1.2% [0.8, 1.6] 1.5% [0.8, 2.2] 1.3% [0.5, 2.1] 1.0% [0.5, 1.5] 0.9% [-0.3, 2.0] 1.4% [-0.2, 3.0] Diseases Liver Disease 2.2% [1.7, 2.7] 1.0% [0.4, 1.7] 0.8% [0.2, 1.5] 2.9% [2.1, 3.6] 3.1% [1.1, 5.2] 6.2% [3.0, 9.3] Kidney 2.0% [1.6, 2.5] 2.5% [1.5, 3.4] 2.2% [1.2, 3.2] 1.6% [1.0, 2.2] 2.4% [0.6, 4.2] 2.3% [0.3, 4.3] Disease HIV/AIDS 4.2% [3.6, 4.9] 0.2% [-0.1, 0.5] 0.4% [-0.0, 0.8] 8.4% [7.2, 9.7] 4.4% [1.9, 6.8] 1.6% [-0.1, 3.3] Other STI’s 7.3% [6.6, 8.1] 1.8% [1.0, 2.5] 2.5% [1.5, 3.6] 12.5% [11.1, 14.0] 7.7% [4.6, 10.8] 6.8% [3.5, 10.1] Sleep 14.7% [13.7, 15.8] 13.4% [11.4, 15.4] 19.1% [16.4, 21.8] 13.9% [12.4, 15.5] 11.8% [8.2, 15.5] 16.6% [11.7, 21.5] Disorders Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 24
Mental health outcomes of LGB respondents
Psychological distress was measured with the Kessler-6 Mental Health Scale, which assesses non- specific psychological distress (Kessler et al., 2003). Respondents were asked to rate how often they felt nervous, hopeless, restless or fidgety, so depressed that nothing could cheer you up, that everything was an effort, and worthless. Respondents were provided with five response options ranging from all of the time to none of the time. The total scale’s values range from 0–24. Based on research and norms developed in the global application of this scale, a total score of 13–24 indicates probable serious mental illness, and 0–12 indicates high probably of no serious mental illness (Kessler et al., 2003). A total score of 5 and above indicates moderate psychological distress. As seen in Table 3, 81% of bisexual women experienced moderate psychological distress compared to 73% of gay men, and 68% of lesbian/gay women.
We also assessed suicidal ideation and attempts. As Table 3 shows, a large proportion of LGB people had thought about suicide and actually attempted suicide (defined as deliberately hurting oneself with intention to die) at least once in their lives, and there was no significant difference overall between men and women. A greater proportion of lesbian/gay women than bisexual women had thoughts about suicide (49% v. 63%) but there was no significant difference between gay and bisexual men. More bisexual women (33%) than lesbian/gay women (22%) had attempted suicide; and 23% of gay men and 22% of bisexual men had also attempted suicide but the difference was not significant.
Mental health outcomes of transgender respondents
Transgender respondents' mean score on the K-6 scale was 9.68. On average, transgender participants scored about 1.73 points higher than gay women, 1.21 points higher than gay men, and 1.13 points higher than bisexual men and the differences in all of these comparisons were significant.
In terms of suicidality, 55% of transgender respondents reported having thoughts about suicide in their lifetime, which was not significantly different than their LGB counterparts. In all, about one in three transgender respondents (31%) had tried to kill themselves by suicide. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 25
Table 3. Mental health outcomes
TOTAL SAMPLE WOMEN (N= 2,138) MEN (N = 2,497) TRANSGENDER (N = 4,867) LESBIAN/GAY BISEXUAL GAY BISEXUAL (N = 232) VARIABLE MEAN/ SD/ MEAN/ SD/ MEAN/ SD/ MEAN/ SD/ MEAN/ SD/ MEAN/ SD/ % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI Psychological Distress (Range 0-24) 8.69 5.62 7.95 5.54 10.04 5.66 8.47 5.45 8.56 5.70 9.68 6.24 Moderate Psychological Distress [71.4, [65.0, [78.0, [70.1, [68.3, [68.9, 72.8% 67.7% 80.8% 72.1% 73.6% 74.7% (≥5) 74.2] 70.5] 83.6] 74.2] 78.8] 80.5] [53.7, [46.1, [60.1, [53.3, [47.9, [48.5, Had Suicidal Thoughts 55.2% 49.1% 63.4% 55.6% 53.7% 55.2% 56.7] 52.0] 66.8] 57.8] 59.6] 61.9] [23.1, [19.1, [29.2, [20.6, [16.6, [24.6, Had Attempted Suicide 24.5% 21.5% 32.5% 22.6% 21.5% 30.9% 25.8] 24.0] 35.8] 24.6] 26.3] 37.1] Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 26
Substance use among LGB respondents
Alcohol use was assessed with the Alcohol Use Disorder Identification Test (AUDIT-C), which uses three items to assess hazardous drinking behavior and active alcohol use disorders (Bush et al., 1998). Respondents were first asked “how often do you have a drink containing alcohol?” Response options included never, monthly or less, 2–4 times a month, 2–3 times a week, and 4 or more times a week. Then they were asked “how many standard drinks containing alcohol do you have on a typical day?“ Response options included none, 1 or 2, 3 or 4, 5 or 6, 7 to 9, and 10 or more. Lastly, respondents were asked “how often do you have six or more drinks on one occasion?” with response options never, less than monthly, monthly, weekly, and daily or almost daily. Recommended screening thresholds to identify alcohol use disorder or risky drinking using the AUDIT-C is 4 or more for men and 3 or more for women (Frank et al., 2008). As seen in Table 4, lesbian/gay respondents scored 4.53 on the scale, while bisexual women scored 4.42—these scores are indicative of problematic alcohol use or risky drinking. Among the men, gay men scored 4.47 and bisexual men scored 4.40, also indicative problematic alcohol use or risky drinking. There was no significant difference in scores between lesbian/gay and bisexual women, between gay and bisexual men, or between men and women.
Drug use was assessed using the Drug Use Disorders Identification Test (DUDIT), which is an 11-item scaled used to identify individuals with drug-related problems (Berman et al., 2003). Scale items include, “have you or anyone else been hurt (mentally or physically) because you used drugs?” and “How often do you use drugs other than alcohol?” The recommended threshold for men is a score of 6, which indicates probable drug-related problems (i.e., substance abuse, harmful use, dependence); the threshold for women is a score of 2 or more. A score of 25 or greater for both men and women is indicative of dependence on one or more drugs (Berman et al., 2003). Bisexual women in the sample scored higher than lesbian/gay women (2.09 v. 1.52) and the difference in scores was statistically significant. According to the suggested threshold of 2, bisexual women in the sample can be identified as having drug-related problems. The reverse was found among men: gay men scored higher than bisexual men (2.24 v. 2.05), but the difference was not significant, and these scores are not indicative of drug-related problems.
Substance use among transgender respondents
Transgender respondents scored the lowest (4.07) for alcohol disorders and risky drinking compared to their LGB counterparts. Using either the established threshold of 4 for cisgender men and 3 for cisgender women, the transgender score of 4.07 indicates problematic alcohol use or risky drinking among transgender men and women in the sample.
Transgender respondents scored the highest (2.90) for drug use compared to LGB respondents, which was significantly higher than bisexual men (2.05), gay men (2.24), bisexual women (2.09), and lesbian/gay women (1.52). Based on the threshold score of 2 or more for women, a score of 2.90 for transgender respondents indicates a probable drug-related problem. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 27
Table 4. Substance use
TOTAL SAMPLE WOMEN (N= 2,138) MEN (N = 2,497) TRANSGENDER VARIABLE (N = 4,867) LESBIAN/GAY BISEXUAL GAY BISEXUAL (N = 232) MEAN SD MEAN SD MEAN SD MEAN SD MEAN SD MEAN SD Alcohol Use (Range: 0-12) 4.45 2.71 4.53 2.62 4.42 2.70 4.47 2.70 4.40 2.69 4.07 3.26 Drug Use (Range: 0-44) 2.05 4.53 1.52 3.99 2.09 4.09 2.24 4.75 2.05 4.28 2.90 6.41 Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 28
MINORITY STRESSORS OF LESBIAN/GAY AND BISEXUAL WOMEN, GAY AND BISEXUAL MEN, AND TRANSGENDER RESPONDENTS IN COLOMBIA
Experiences of victimization among LGB respondents
Table 5 shows that almost all gay men (71%), bisexual men (65%), lesbian/gay women (60%), and bisexual women (61%) experienced verbal assault over their lifetime. Twenty-five percent of gay men, 23% of bisexual men, 21% of lesbian/gay women, and 17% of bisexual women had been beaten or physically assaulted, and 20% of all LGB men and women had been sexually assaulted.
Although the level of exposure to victimization was very high among all LGB people, a higher proportion of men than women experienced victimization. More gay men (33%) and bisexual men (31%) experienced their property being stolen, vandalized, or intentionally damaged than did lesbian/ gay women (22%) and bisexual women (17%; the difference between bisexual men and women is not statistically significant). Also, more gay men (31%) and bisexual men (29%) were victims of attempted attack than lesbian/gay (20%) and bisexual women (23%; again the difference between bisexual men and women is not statistically significant). A higher proportion of gay (40%) and bisexual men (43%) have been threatened with violence than lesbian/gay (27%) and bisexual women (29%) and a higher proportion of gay (29%) and bisexual men (30%) experienced having an object thrown at them than lesbian/gay (20%) and bisexual women (21%).
We also look at whether the victimization experiences were perpetrated by armed groups (e.g., guerrillas, paramilitaries) outside the law (Table 6). Among LGB respondents, between 3-8% experienced victimization perpetrated by armed groups (i.e., guerrillas and paramilitaries), with no notable statistically significant differences among LGB men and women.
Experiences of victimization among transgender respondents
Table 5 also shows victimization among transgender respondents. As with LGB respondents, almost all (76%) have experienced verbal assault over their lifetime, 36% of transgender respondents reported being beaten or physically attacked in their lifetime, and 27% had been sexually assaulted. A higher proportion of transgender respondents (47%) than lesbian/gay (27%) and bisexual women (29%) were threatened with violence; 40% of transgender respondents had an object thrown at them compared to 20% of lesbian/gay and 21% of bisexual women. Differences in exposure to victimization between transgender respondents and gay and bisexual men were not statistically significant.
In terms of violence by armed groups, a higher proportion of transgender respondents who had experienced victimization had this perpetrated by armed groups members (Table 6). For example, 22% of transgender respondents who were beaten or physically attacked reported that this was perpetrated by armed groups members and for 15% of transgender respondents who were sexually assaulted the assault was perpetrated by armed groups members. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 29
Table 5. Experiences of victimization
TOTAL SAMPLE CISGENDER WOMEN (N = 2,138) CISGENDER MEN (N = 2,497) TRANSGENDER (N = 4,867) LESBIAN/GAY BISEXUAL GAY BISEXUAL (N = 232) VARIABLE EVER EVER EVER EVER EVER EVER % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI [65.0, [57.5, [57.9, [69.3, [59.5, [69.7, Someone verbally assaulted you 66.6% 60.5% 61.4% 71.5% 65.1% 75.7% 68.2] 63.6] 64.9] 73.7] 70.8] 81.7] Someone threatened you with [33.4, [24.3, [25.6, [37.1, [37.5, [40.4, 35.0% 27.0% 28.9% 39.6% 43.3% 47.3% violence 36.6] 29.7] 32.2] 42.1] 49.2] 54.2] Property stolen, vandalized, or [26.3, [19.0, [20.1, [30.4, [25.7, [23.2, 27.9% 21.6% 23.1% 32.7% 31.3% 29.4% intentionally damaged 29.4] 24.2] 26.1] 35.1] 36.9] 35.6] Someone tried to attack you, steal [25.3, [18.0, [19.6, [29.2, [23.7, [22.6, or damage your property but was 26.8% 20.4% 22.7% 31.5% 29.2% 29.0% 28.3] 22.9] 25.7] 33.8] 34.7] 35.3] not successful [24.6, [17.3, [18.2, [27.3, [24.3, [33.8, Someone threw an object at you 26.0% 19.7% 21.1% 29.6% 29.7% 40.5% 27.5] 22.1] 24.0] 31.9] 35.2] 47.2] [21.3, [18.6, [14.3, [22.5, [18.3, [29.5, Beaten or physically attacked 22.8% 21.0% 17.1% 24.6% 23.5% 36.1% 24.2] 23.5] 19.8] 26.7] 28.8] 42.6] [19.2, [18.0, [19.1, [17.4, [15.2, [21.0, Sexually assaulted 20.5% 20.6% 22.0% 19.3% 20.2% 27.0% 21.9] 23.1] 24.9] 21.2] 25.1] 32.9] Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 30
Table 6. Victimization by armed groups among those who reported ever experiencing victimization
CISGENDER WOMEN CISGENDER MEN TOTAL SAMPLE TRANSGENDER VARIABLE LESBIAN/GAY BISEXUAL GAY BISEXUAL % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI Someone verbally assaulted you 3.2% [2.5, 4.0] 2.5% [1.3, 3.7] 1.4% [0.2, 2.6] 3.0% [1.9, 4.1] 3.3% [0.6, 6.0] 13.7% [8.4, 18.9] Someone threatened you with 5.0% [3.8, 6.2] 4.0% [1.6, 6.3] 3.7% [1.1, 6.2] 4.8% [3.2, 6.4] 5.1% [1.0, 9.3] 12.3% [5.9, 18.8] violence Property stolen, vandalized, or [-0.1, 8.5% [6.6, 10.4] 9.8% [5.8, 13.8] 6.0% [2.1, 9.8] 8.5% [5.9, 11.0] 4.9% 17.3% [7.6, 26.9] intentionally damaged 10.0] Someone tried to attack you, steal or damage your property 7.7% [6.1, 9.4] 5.9% [2.7, 9.1] 6.9% [3.0, 10.7] 8.0% [5.7, 10.2] 6.0% [0.4, 11.7] 17.3% [7.6, 26.9] but was not successful Someone threw an object at you 3.5% [2.3, 4.7] 1.6% [-0.3, 3.4] 2.0% [-0.2, 4.3] 3.3% [1.8, 4.9] 3.8% [-0.5, 8.1] 12.3% [5.3, 19.2] [12.4, Beaten or physically attacked 7.6% [5.5, 9.7] 3.8% [1.2, 6.4] 3.8% [0.0, 7.6] 8.2% [5.1, 11.3] 8.3% [0.8, 15.8] 21.8% 31.2] Sexually assaulted 4.6% [3.0, 6.1] 2.9% [0.6, 5.1] 1.5% [-0.6, 3.6] 5.8% [3.1, 8.5] 2.6% [-2.3, 7.5] 15.2% [5.8, 24.7] Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 31
Stressful life events among LGB respondents
Stressful life events were very prevalent among LGBT respondents (Table 7). A quarter of LGBT respondents said they were fired from or denied a job in their lifetime and fully 75% reported they were bullied at least once before age 18. There are a few statistically significant differences between LGB men and women: 27% of gay men were fired from or denied a job compared to 20% of bisexual men. And although most LGBT respondents experienced bullying before age 18, an even higher proportion of gay (84%) and bisexual men (81%) were victims of bullying before age 18 than lesbian/ gay (62%) and bisexual women (68%).
Stressful life events among transgender respondents
More transgender respondents than LGB respondents experienced being fired from a job or denied a job (40%) and were denied a promotion or received a negative evaluation at work (30%). And about twice as many transgender respondents (17%) as LGB men and women (6–8%) have been stopped by a landlord or real estate agency from moving into or buying a home or apartment.
Almost all (85%) of transgender respondents were bullied before age 18, and this did not differ statistically from gay (84%) and bisexual men’s (81%) experiences. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 32
Table 7. Stressful life events
TOTAL SAMPLE WOMEN (N= 2,138) MEN (N =2,497) TRANSGENDER VARIABLE (N = 4,867) LESBIAN/GAY BISEXUAL GAY BISEXUAL (N = 232) % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI [24.3, [23.2, [18.1, [24.8, [14.8, [33.4, Since the age of 18 was fired from or denied a job 25.8% 25.9% 21.2% 27.0% 19.7% 40.1% 27.2] 28.5] 24.2] 29.1] 24.7] 46.8] Since the age of 18, denied a promotion or received [17.7, [15.6, [14.0, [18.0, [11.1, [23.7, 19.0% 18.0% 16.7% 19.9% 15.5% 29.8% a negative evaluation 20.3] 20.3] 19.4] 21.8] 20.0] 36.0] Since the age of 18, stopped by a landlord or real [6.4, [6.3, [3.7, [5.3, [4.3, [12.4, estate agency from moving or buying a house or 7.3% 8.0% 5.5% 6.5% 7.5% 17.5% 8.2] 9.7] 7.3] 7.7] 10.8] 22.6] apartment [73.8, [58.7, [64.8, [82.3, [76.8, [79.4, Was a victim of bullying before age 18 75.4% 61.8% 68.4% 84.1% 81.5% 84.6% 76.9] 64.8] 71.9] 86.0] 86.3] 89.8] Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 33
Everyday discrimination experiences of LGB respondents
Everyday discriminatory experiences (also referred to as microaggressions) are stressors that are of lesser magnitude than major life events (magnitude of stress experiences is measured as how much change they caused that requires adaptation). As with major life events, everyday experiences of discrimination, or microaggressions, were a common experience for LGBT respondents (Table 8).
Among men, there were no differences in how gay and bisexual men experienced everyday discrimination. However, there are differences by gender. Compared to lesbian/gay women, more gay men reported everyday discrimination such as people treated them as not smart (52% v. 46%), people acted afraid of them (47% v. 40%), people acted as if they were dishonest (41% v. 31%), people called them by offensive nicknames or insulted them (73% v. 52%), and people threatened or harassed them (41% v. 31%). When comparing bisexual men and women, however, we find that experiences are similar with the exception 68% of bisexual men were called offensive nicknames or insulted compared to 52% of bisexual women.
Everyday discrimination experiences of transgender respondents
Transgender respondents reported more instances of discrimination (listed in Table 8) than LGB men and women. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 34
Table 8. Everyday discrimination
TOTAL SAMPLE WOMEN (N= 2,138) MEN (N = 2,497) TRANSGENDER VARIABLE (N = 4,867) LESBIAN/GAY BISEXUAL GAY BISEXUAL (N = 232) % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI [68.6, [63.9, [66.2, [69.3, [61.2, [77.4, You were treated with less courtesy than others 70.2% 66.8% 69.6% 71.5% 67.0% 82.8% 71.8] 69.8] 73.0] 73.8] 72.8] 88.2] [63.5, [59.3, [59.0, [64.1, [58.0, [73.8, You were treated with less respect than others 65.1% 62.3% 62.6% 66.3% 64.1% 79.5% 66.7] 65.3] 66.2] 68.6] 70.3] 85.2] You have received worse service than others in [46.8, [45.6, [44.0, [45.6, [37.0, [56.1, 48.5% 48.8% 47.6% 48.1% 42.9% 63.1% restaurants or stores 50.3] 51.9] 51.3] 50.6] 48.9] 70.1] People have acted as if they thought you are not [49.2, [43.2, [48.4, [49.6, [40.8, [58.1, 50.9% 46.3% 52.1% 52.1% 47.0% 64.8% smart 52.6] 49.4] 55.8] 54.6] 53.1] 71.4] [43.0, [37.1, [37.5, [44.9, [38.0, [51.4, People have acted as if they were afraid of you 44.6% 40.1% 41.1% 47.3% 43.9% 58.3% 46.2] 43.0] 44.7] 49.8] 49.8] 65.2] People have acted as if they thought you were [37.1, [28.7, [32.9, [39.0, [34.8, [50.6, 38.8% 31.5% 36.6% 41.5% 40.7% 57.6% dishonest 40.5] 34.4] 40.2] 44.0] 46.6] 64.7] People have acted as if they were better than [71.3, [66.8, [72.7, [71.0, [63.8, [72.2, 72.8% 69.6% 76.0% 73.2% 69.2% 78.0% you 74.2] 72.4] 79.2] 75.4] 74.7] 83.7] They have called you by offensive nicknames or [62.1, [49.0, [48.2, [70.6, [62.1, [74.9, 63.7% 52.1% 51.8% 72.8% 67.8% 80.6% insulted you 65.4] 55.3] 55.5] 75.1] 73.5] 86.3] [36.9, [27.9, [32.7, [38.2, [38.4, [53.3, They have threatened or harassed you 38.5% 30.7% 36.3% 40.6% 44.4% 60.1% 40.0] 33.5] 39.8] 43.0] 50.4] 66.8] Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 35
LGBT respondents’ interaction with police
We asked respondents what their interactions with the police have been like in the year prior to taking the survey. Overall, 20% reported that the police or state officials have been verbally abusive and 11% reported physical abuse (Table 9).
More transgender respondents (29%) were verbally abused by police than lesbian/gay (17%) and bisexual women (16%). And a significantly higher proportion of transgender respondents (24%) have been physically abused by police compared to gay (12%) and bisexual men (12%) and lesbian/gay (9%) and bisexual women (7%).
Table 9. Interaction with police
TOTAL SAMPLE WOMEN (N= 2,138) MEN (N = 2,497) TRANSGENDER (N = 4,867) LESBIAN/GAY BISEXUAL GAY BISEXUAL (N = 232) VARIABLE 95% 95% 95% 95% 95% 95% % % % % % % CI CI CI CI CI CI Verbally abused by the police or [18.8, [14.7, [13.6, [20.4, [15.2, [23.2, 20.1% 17.1% 16.3% 22.4% 19.9% 29.5% state officials in 21.4] 19.4] 19.0] 24.4] 24.7] 35.8] the past year Physically abused by the [10.1, [7.6, [4.9, [10.8, [8.4, [18.2, police or state 11.20% 9.4% 6.8% 12.4% 12.5% 24.0% 12.2] 11.1] 8.7] 14.1] 16.7] 29.8] officials in the past year
INTERNALIZING MINORITY STRESS PROCESSES In addition to minority stress processes such as victimization and discrimination, LGBT people may experience internalizing minority stress processes. Internalizing minority stress processes include stressors that work through the person’s internalizing of societal stigma and prejudice, thus, LGBT people experience stress by internalizing homophobic and transphobic attitudes and directing these negative attitudes toward themselves (Meyer, 2003). In Table 10, we describe minority stress processes. Although the constructs are similar for LGB and transgender people, some of the measures differ between LGB and transgender people because of the differences in the quality of homophobia and transphobia (we therefore do not provide results under the total sample column as indicated in Table 10).
LGB respondents
Internalized homophobia is a scale that examines the extent to which a respondent agrees with stigma against homosexuality as part of their own value systems (Herek et al., 2009). This scale includes statements such as “I have tried to stop being attracted to people who are the same sex as me” and “I wish I weren’t LGB.” Responses are coded on a 5-point Likert scale ranging from 1, “strongly disagree” to 5, “strongly agree.” The scale summary is a mean score of all the items with lower values representing less internalized homophobia and higher values, greater internalized homophobia. As Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 36
can be seen in Table 10, bisexual men (2.36) reported the highest level of internalized homophobia, followed by bisexual women (2.02), gay men (1.93), and lesbian/gay women (1.89). The difference between gay men and lesbian/gay women is not statistically significant.
Felt stigma is a scale that assesses respondents’ expectations of rejection and discrimination (Herek, 2008). This scale asks respondents to respond to statements such as “most employers where I live will hire openly LGB people if they are qualified for the job” and “most people where I live would not want someone who is openly LGB to take care of their children.” Answer options range from 1, “strongly disagree” to 5, “strongly agree” on a 5-point Likert scale. The scale score represents the mean response across all items, lower values represent low felt stigma and higher values represent great felt stigma, ranging from 1to 5. As Table 10 shows, bisexual women reported the highest felt stigma (3.12), followed by bisexual men (3.10), lesbian/gay women (3.03) and gay men (2.91). The difference between bisexual women and men, and bisexual men and lesbian/gay women, is not statistically significant.
Identity centrality We used a 5-item subscale from the Lesbian, Gay, and Bisexual Identity Scale (LGBIS) to assess the degree to which respondents’ sexual identities were central to their overall identity (Mohr and Kendra, 2011). The scale includes items such as “my sexual orientation is an insignificant part of who I am” and “being an LGB person is a very important aspect of my life.” Response were recorded on a 6-point Likert scale ranging from 1, “disagree strongly” to 6, “agree strongly” and the scale was created as a mean score of all items. Lower values represent lower centrality and higher values represent greater centrality of LGBT identity. As Table 10 shows, bisexual men (3.6) and women (3.9) reported lower sexual identity centrality compared with lesbian/gay women (4.2) and gay men (4.1).
Identity concealment To assess level of identity concealment among LGB men and women, respondents were asked to rate their level of outness to family, heterosexual friends, coworkers, and health service providers. We reported proportions of people who reported that they were out to all, most, or some of the people in these respective groups as compared to being out to none. Table 10 shows that a higher proportion of lesbian/gay women (88%) and gay men (89%) were out to family member than bisexual women (66%) and bisexual men (68%). Compared to bisexual men (87%), more lesbian/gay women (96%), gay men (96%), and bisexual women (94%) were out to their heterosexual friends. More gay men (75%) were out to their coworkers compared to lesbian/gay women (66%), bisexual women (50%), and bisexual men (55%).
In terms of outness to healthcare providers, 75% of gay men, 61% of lesbian/gay women, 56% of bisexual men, and 42% of bisexual women were out to their healthcare providers. Though the difference between lesbian/gay women and bisexual men is not statistically significant, all other differences are.
We also measured the degree to which respondents were out as youth (in high school). A larger proportion of gay men (21%) were out to everyone in high school compared with bisexual men (9%), lesbian/gay women (14%), and bisexual women (13%). Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 37
Transgender respondents
Internalized transphobia Like internalized homophobia, this scale assesses the extent to which respondents accept stigma about transgender identity as part of their own value systems (Testa et al., 2015). Scale items include statements such as “I resent my transgender identity” and “I ask myself why I can’t just be normal?” and response options are a 5-point Likert scale ranging from “strongly disagree” to “strongly agree.” The scale score is the mean score of all items within the scale ranging from 1 to 5 with the lower value representing less internalized transphobia and the higher values representing greater internalized transphobia. As shown in Table 10, transgender respondents report an average 2.1 score of internalized transphobia.
Identity concealment To assess concealment in transgender people we used the Gender Identity Non-disclosure 5-item scale which assesses the degree to which respondents avoid disclosing their gender identity to others (Testa et al., 2015). Statements include “I don’t talk about certain experiences from my past or I change parts of what I tell people” and “I modify my way of speaking.” Response options are a 5-point scale ranging from “strongly disagree” to “strongly agree.” The scale is created as a mean score of all items. Scale values range from 1 to 5, with lower values representing less of an effort to avoid disclosure and a higher value represents a larger effort to avoid disclosure. Transgender respondents had a mean value of 2.9.
LGBT visibility
Finally, we asked respondents how often they thought other people could tell that they were LGBT even they did not disclose this information. Table 10 shows that 49% of transgender respondents said they were always or most of the time identified as transgender, compared to 36% of gay men, 26% of lesbian/gay women, 23% of bisexual men, and 14% of bisexual women. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 38
Table 10. Minority stress processes
TOTAL SAMPLE WOMEN (N= 2,138) MEN (N = 2,497) TRANSGENDER (N = 4,867) LESBIAN/GAY BISEXUAL GAY BISEXUAL (N = 232) VARIABLE MEAN/ SD/ 95% MMEAN/ SD/ MMEAN SD/ MMEAN/ SD/ MMEAN/ SD/ 9 % 95% CI % CI % 95% CI /% 95% CI % 95% CI % 5% CI Internalized Homophobia (Range: 1–5)/ Internalized Transphobia -- -- 1.89 0.79 20.02 0.82 1.93 0.86 2.36 0.99 2.07 0.94 (Range: 1–5) Felt Stigma (Range: 1–5) -- -- 3.04 0.91 30.12 0.94 2.91 0.90 3.10 0.87 -- -- Sexual Identity Centrality -- -- 4.2 1.0 0.9 1.0 4.1 1.0 3.6 1.1 -- -- Concealment (Range: 1–5) ------2.9 1.1 [85.8, [62.6, [87.7, [63.1, Out to some, most, or all family -- -- 87.8% 65.9% 89.1% 68.4% -- -- 89.8] 69.2] 90.6] 73.7] Out to some, most, or all [95.3, [92.8, [95.3, [82.8, -- -- 96.4% 94.4% 96.2% 86.7% -- -- heterosexual friends 97.6] 96.0] 97.1] 90.6] Out to some, most, or all [65.7, [46.5, [73.2, [49.4, -- -- 68.5% 50.0% 75.2% 55.2% -- -- coworkers 71.3] 53.5] 77.2] 60.9] Out to health service [58.4, [38.9, [73.1, [50.6, -- -- 61.3% 42.3% 75.1% 56.6% -- -- professionals 64.3] 45.8] 77.0] 62.5] Being Out in High School [12.0, [10.8, [18.8, [5.6, Everyone/most -- -- 14.0% 13.1% 20.6% 8.9% -- -- 16.0] 15.3] 22.3] 12.3] [27.1, [30.8, [27.9, [27.8, Some/few -- -- 29.7% 34.0% 29.9% 33.1% -- -- 32.3] 37.2] 31.9] 38.4] [53.5, [49.6, [47.4, [52.5, No one -- -- 56.3% 53.0% 49.5% 58.0% -- -- 59.1] 56.3] 51.7] 63.5] Visibility [27.6, [23.7, [11.1, [33.5, [17.6, [42.6, Forever/Most of the time 29.1% 26.5% 13.6% 35.8% 22.9% 49.3% 30.5] 29.2] 16.1] 38.0] 28.2] 56.0] [52.6, [51.9, [52.6, [51.1, [52.8, [36.0, Sometimes/Occasionally 54.1% 54.9% 56.1% 53.4% 58.8% 42.6% 55.7] 57.9] 59.7] 55.7] 64.7] 49.3] [15.6, [16.2, [27.1, [9.4, [13.8, [4.2, Never 16.8% 18.6% 30.3% 10.8% 18.3% 8.0% 18.0] 21.1] 33.5] 12.2] 22.9] 11.9]
Note: -- indicates Not Applicable because the group was not asked the question or not asked the same set of questions, thus, a total percentage is not provided. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 39
AGE OF COMING OUT MILESTONES (LGB) AND GENDER IDENTITY MILESTONES (TRANSGENDER)
LGB respondents
Figure 3 presents the mean ages when LGB respondents experienced coming out milestones by gender (men and women). Overall, gay men followed by bisexual men reported younger mean ages for coming out milestones than did lesbian/gay and bisexual women, though this difference is not statistically significant.
Figure 3. Age of coming out milestones
20 20 19 19
19 18
18 18 17 17
17 16 16
16
15 15 AGE MEASURE NAMES BISEXUAL MEN BISEXUAL WOMEN 13 13 GAY MEN LESBIAN/GAY WOMEN*
11
10
FELT SEXUALLY HAD HAD FIRST INTIMATE REALIZED, SOMEONE IN TOLD A TOLD A ATTRACTED TO CONSENSUAL RELATIONSHIP WITH FOR THE YOUR FAMILY HETEROSEXUAL MEMBER OF SOMEONE OF SEX WITH SOMEONE OF THE FIRST TIME, HAD REALIZED FRIEND THAT YOUR FAMILY THE SAME SEX SOMEONE OF SAME SEX, WHERE YOU THAT YOU YOU WERE LGB YOU WERE LGB THAT YOU FOR THE FIRST THE SAME SEX BOTH FELT IN LOVE WERE LGB? BEFORE YOU FOR THE FIRST WERE LGB FOR TIME FOR THE FIRST OR ROMANTICALLY TOLD THEM TIME THE FIRST TIME TIME INVOLVED
*Note: The gray line for lesbian/gay women is not visible because their trajectory is the same as and overlaps with the line for bisexual women until age 18 (told a heterosexual friend) when it overlaps with the line for bisexual men, such that their ages, left to right, are 13, 18, 19, 16, 19, 18, 20. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 40
Transgender respondents Figure 4. Age of gender identity milestones
Age 11 is the mean age at which 20
transgender respondents felt their 19 gender was “different” from the one they were assigned at birth (Figure 4). At age 19, transgender respondents began to tell others they were transgender.
15 CONVERSION THERAPY AGE 14 LGB respondents
One in five (21%) of LGBT respondents have received 11 treatment from someone who 10 tried to change their sexual FELT YOUR GENDER BEGAN TO THINK THAT TOLD OTHERS THAT YOU WAS “DIFFERENT” FROM YOU WERE TRANSGENDER WERE TRANSGENDER orientation or someone who THE ONE YOU WERE (EVEN IF YOU DID NOT (EVEN IF YOU DID NOT ASSIGNED AT BIRTH KNOW THE WORD) USE THAT WORD) tried to make them identify with their assigned sex at birth (Table 11). While 25% of lesbian/gay women reported experiencing this, 17% of bisexual women received this treatment. The difference between bisexual women (17%) and bisexual men (21%) is statistically significant, however, no other differences are.
Transgender respondents
Transgender respondents reported the highest rate (35%) of having received treatment from someone who wanted to make them identify as their assigned sex at birth compared to LGB men and women.
Table 11. Conversion therapy
TOTAL SAMPLE WOMEN (N = 2,138) MEN (N=2,497) TRANSGENDER (N = 4,867) LESBIAN/GAY BISEXUAL GAY BISEXUAL (N=232) VARIABLE 95% 95% 95% 95% 95% 95% % % % % % % CI CI CI CI CI CI Received treatment from someone who tried to change your sexual orientation [19.7, [22.1, [14.1, [18.8, [15.8, [28.9, or from someone 21.0% 24.6% 16.8% 20.7% 20.8% 35.5% 22.4] 27.2] 19.6] 22.7] 25.7] 42.0] who tried to make you identify only with your assigned sex at birth Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 41
COMMUNITY CONNECTEDNESS We measure community connectedness using a 7-item scale (Frost & Meyer, 2012) that assesses the desire for and strength of LGBT community affiliation among respondents. The scale includes questions such as “you feel you’re a part of the LGBT community” and “you are proud of the LGBT community.” Reponses are recorded on a 4-item scale ranging from “agree strongly” to “disagree strongly.” A mean score is created of each of the items within the scale and the final scale was reverse-coded so that lower scores represent lower community connectedness, while a higher score represents greater community connectedness. The scale ranges from 1-4 (Kruger et al, 2015).
We also asked respondents whether they thought their city, municipality, town, or area they lived was a good or bad place to live for gay, lesbian, bisexual people and transgender people. In Table 12, we report the percentages of respondents who answered their area of residence is a bad place to live for LGBT people.
LGB respondents
As a group, LGBT respondents report a community connectedness score of 3.17, indicating higher community connectedness. Respondents agreed with statements saying they feel like they are a part of the LGBT community, are proud of the LGBT community, and have a bond with the LGBT community. Additionally, 56.2% of LGBT people believe the area in which they live is bad for transgender people to live. Thirty-seven percent believe the area is a bad place to live for LGB people. Lesbian/gay (3.23) and bisexual (3.24) women report a higher score of community connectedness than did gay (3.12) and bisexual men (2.91), with bisexual men reporting the lowest score. There is no difference between LGB men and women and how they rate whether they believe their area of residence is good or bad for LGB and transgender people to live, though all believe that their area is worse for transgender people than LGB people.
Transgender respondents
Compared to LGB men and women, transgender respondents reported higher levels of community connectedness at 3.44. Transgender respondents rated the area they live no differently than their cisgender LGB counterparts in terms of being a bad place to live for LGB people. However, compared to lesbian/gay (53%) and bisexual women (59%) and gay (56%) and bisexual (62%) men, fewer transgender people (44%) rated where they live a bad place for transgender people. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 42
Table 12. Community connectedness
TOTAL SAMPLE WOMEN (N = 2,138) MEN (N=2,497) TRANSGENDER (N = 4,867) LESBIAN/GAY BISEXUAL GAY BISEXUAL (N=232) VARIABLE MEAN/ SD/ MEAN/ SD/ MEAN/ SD/ MEAN/ SD/ MEAN/ SD/ MEAN/ SD/ % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI Community Connectedness (Range 1–4) 3.17 0.60 3.23 0.56 3.24 0.51 3.12 0.63 2.91 0.66 3.44 0.50 Lives in a city/municipality/town or area [35.4, [32.5, [37.4, [33.7, [34.1, [29.4, that is bad for gay, lesbian or bisexual 37.2% 35.7% 41.3% 36.2% 39.8% 36.1% 39.0] 38.8] 45.2] 38.6] 45.5] 42.9] people to live in Lives in a city/municipality/town or area [54.3, [49.5, [55.0, [54.9, [56.1, [36.8, that is bad for transgender people to 56.2% 52.8% 58.8% 57.5% 62.0% 43.7% 58.0] 56.1] 62.5] 60.0] 67.9] 50.6] live in Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 43
STUDY LIMITATIONS
There are several limitations that ought to be considered in evaluating the data.
Because the recruitment method targeted online platforms and venues in which LGBT people were known to access or frequent, the sample could be biased to respondents who are out as LGBT or respondents who have some affiliation with the LGBT community. These respondents may have stronger social support systems and better outlets to cope with stress related to their sexual orientation and gender identity than LGBT people who are more closeted or have no affiliation with the LGBT community. In other words, respondents may be LGBT people who fare better than those who were not part of the survey.
Related to recruitment methods, our sample is also biased to the younger population. The overall youth of the respondents in the sample would impact prevalence estimates for health problems that are more prevalent at older ages, such as hypertension or cardiovascular diseases. On the other hand, the young age may be related to underestimation of some lifetime prevelances. This is because compared with younger people, older people would report more events and conditions over a lifetime simply because they have more years in their lifetime and therefore more chance of having experienced any particular experience.
The results also do not reflect the experiences of the most marginalized LGBT people. The study’s eligibility criteria required respondents to have access to the internet via smartphone, tablet, or computer; to have completed at least 4th grade education (to ensure literacy and ability to complete the self-administered questionnaire), and time to complete the survey. These factors may have excluded LGBT people who are poorer, less educated, and may fare worse than the results from the study participants.
Similarly, LGBT people are subject to stigma and prejudice that may inhibit disclosure of their LGBT identity to researchers. Although the survey was anonymous, some people may have not been willing to participate and reveal intimate data about themselves for fear of being discovered. Similarly, although we included as eligible any LGBT person who lives in Colombia regardless of nationality, some people who are undocumented, such as many Venezuelan and other refugees in Colombia, may have feared to participate for the same reasons.
Still, the study provides helpful information and insight into the experiences of LGBT people living in Colombia who met the recruitment criteria and were available to participate. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 44
CONCLUSIONS
This study is the largest and most comprehensive study ever conducted about LGBT people in Colombia. Our results show that exposure to minority stress, discrimination, and violence is a commonplace experience for LGBT people and that they exhibit serious adverse health outcomes.
Most of the respondents to our survey (76%) were between the ages of 18 and 29 years old. This is, in part, due to the sampling approach, using venues in the community, that probably represents younger people. But the younger age of the respondents also represents the fact that more younger people are identified as LGBT (Newport, 2018). Despite this, our large number of respondents overall will allow us to report on subsamples, including older LGBT people.
Our sample is very diverse in terms of gender, gender identity, residential geographic distribution, and social class. Although 44% of our respondents were college educated, another 44% had lower than the minimum legal salary in Colombia and 37% had a socioeconomic status level of 3, in the middle of the 1–6 Colombian social strata classification. Significantly more transgender respondents (25%) were at the lowest economic status (level 1) compared to cis-gender LGB men and women (8%–13%).
Almost half of the LGBT respondents had no formal religion, identifying themselves as atheist, agnostic, spiritual, or non-religious. This high proportion of non-religious people is not surprising, based on data from LGBT populations in the U.S. regarding rejection of their LGBT identity by many religious institutions. Similarly, in the Colombian context it may reflect the concern among LGBT people about rejection from religious institutions, including the Catholic Church, which is Colombia’s biggest religious denomination.
In terms of health, despite reporting that they had good, very good, or excellent general health, 72% of the respondents reported at least moderate psychological distress. Consistent with the high proportion of psychological distress, we found that an alarming 55% of the LGBT people had suicidal thoughts in their lifetime and one in four (25%) had attempted suicide at least once. Bisexual women (33%) and transgender people (31%) had a highest rate of suicide attempts, with one in three people reporting they attempted suicide at least once.
All LGBT people experienced high levels of victimization such as being threatened with violence, beaten, physically attacked or sexually assaulted. This was especially high among transgender people and gay/bisexual men. This is consistent with reports on the targeting of transgender people, especially transgender women and gay/bisexual men by paramilitary groups and others in Colombian society. Overall, 20% of LGBT people reported that the police or state official have been verbally abusive and 11% reported physical abuse. Experiences of verbal (29%) and physical (24%) abuse by police were especially high for transgender people.
Similarly, 75% reported they were bullied at least once before 18 years old. Twenty-five percent of LGBT said they were fired from or denied a job in their lifetime. Everyday experiences of discrimination, or microaggressions, were a common experience for LGBT people. Most of the respondents (73%) reported that people had acted as if they were better than them and 70% reported Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 45
they were treated with less courtesy than others. Transgender people reported significantly higher rates of experiencing microaggressions than cisgender LGB people.
We also inquired about sexual orientation and gender identity change treatment (also referred to as conversion therapy). We found a very high proportion (21%) of LGBT people in Colombia have received treatment from someone who tried to change their sexual orientation or someone who tried to make them identify with their assigned sex at birth. Transgender people reported the highest rate (35%) of having received this treatment.
Finally, we examined how connected LGBT people in Colombia are to the LGBT community. We found that LGBT people felt a desire for and high affiliation to the LGBT community. Additionally, 63% of LGBT people felt where this lived was a good place for LGB people to live, whereas 43% felt where they lived was a good place for transgender people to live.
RECOMMENDATIONS To address our study’s limitation, and to improve knowledge about LGBT people in Colombia we recommend:
1. Conduct research that provides a comprehensive understanding of the lives of LGBT people under age 18 in Colombia in the following areas: family support and relationships; exposure to conversion therapy, bullying, and discrimination and violence; health and well-being, including psychological distress, drug use, alcohol use, and suicidality; and resilience, social support, and connection with the LGBT community. 2. Conduct targeted research that identifies issues across the lifespan and, in particular, provide a greater perspective on LGBT people over the age of 50 in order to understand the stressors and social and health challenges they face. 3. Collect data that identifies LGBT people in national and regional public health data collection efforts so that data on LGBT people can inform national and local policies. 4. Create systems for data collection and documentation of violence against LGBT people, including mechanisms for reporting forms of police violence.
Our results also reveal several areas in need of policy response from state and city government:
1. Implement suicide prevention programs to specially target LGBT people and promote interventions on mental health in general and psychological distress in particular. 2. Develop and implement a program to identify and assist LGBT victims of violence, providing culturally relevant and LGBT-informed prevention and mental health services. 3. Design public policies beyond the Colombia reparations framework of the peace accords to address the high levels of physical and sexual violence against LGBT communities perpetrated by multiple actors in society, including the police. 4. Throughout agencies and across sectors, the government should assess preparedness of health and social service providers to cater to the needs of LGBT people. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 46
REFERENCES
Alcaldía Mayor de Bogotá, Secretaria Distrital de Planeación. Por una ciudad de derechos. Lineamientos generales de la política pública para la garantía plena de los derechos de las personas lesbianas, gays, bisexuales y transgeneristas —LGBT— y sobre identidades de género y orientaciones sexuales en el distrito capital; 2008 [cited 2015 jun 17]. Available from: http://goo. gl/Dxs1i0. Ardila, R. (2015). History of LGBT issues and psychology in Colombia. Psychology of Sexualities Review, 6, 74-80. Barreto, I., Sandoval, M., & Cortés, O. F. (2010). Prácticas de consumo y estilo de vida de la población LGTB de Bogotá. Diversitas: Perspectivas en psicología, 6(1), 165-184. Berman, A.H., Bergman, H., Palmstierna, T., & Schlyter, F. (2003). The Drug Use Disorders Identification Test (DUDIT) Manual. Retrieved from: http://www.paihdelinkki.fi/sites/default/files/duditmanual.pdf Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Archives of Internal Medicine, 158(16), 1789-1795. Colombia Diversa y Caribe Afirmativo (2018). LA DISCRIMINACIÓN, una guerra que no termina. Informe de Derechos Humanos de Personas Lesbianas, Gays, Bisexuales y Trans. Colombia Diversa (2017). VIVIR BAJO SOSPECHA. Estudios de caso: personas LGBT víctimas del con icto armado en Vistahermosa y San Onofre. Colombia Diversa, Caribe Afirmativo y Santamaría Fundación (2018). Sistema de información de violencia contra personas LGBT en Colombia, mayo de 2018. Corrales, J., & Pecheny, M. (2010). The politics of sexuality in Latin America. University of Pittsburgh Pre. DANE (2019) Censo Nacional de Población y Vivienda 2018 (4 de Julio de 2019) Recuperado de: https://www.dane.gov. co/index.php/estadisticas-por-tema/demografia-y-poblacion/censo-nacional-de-poblacion-y-vivenda-2018 Frank, D., DeBenedetti, A.F., Volk, R.J., Williams, E.C., Kivlahan, D.R., & Bradley, K.A. (2008). Effectiveness of the AUDIT-C as a screening test for alcohol misuse in three race/ethnic groups. Journal of General Medicine, 23 (6), 781-787. Frost, D. M., Lehavot, K., & Meyer, I. H. (2013). Minority stress and physical health among sexual minority individuals. Journal of Behavioral Medicine, 1–8. http://doi.org/10.1007/ s10865-013-9523-8 Frost, D. M., & Meyer, I. H. (2009). Internalized homophobia and relationship quality among lesbians, gay men, and bisexuals. Journal of Counseling Psychology, 56(1), 97-109. Frost, D. M., & Meyer, I. H. (2012). Measuring community connectedness among diverse sexual minority populations. Journal of Sex Research, 49(1), 36–49. Fundación Sergio Urrego (2017) Primera Clínica Para Niños Trans En Colombia. Consultado el 28 de Agosto de 2019. Recuperado de: https://fundacionsergiourrego.org/primera-clinica-para-ninos-trans-en-colombia/ Haas, A.P. & Lane, A. (2015). Collecting Sexual Orientation and Gender Identity Data in Suicide and Other Violent Deaths: A Step Towards Identifying and Addressing LGBT Mortality Disparities. LGBT Health, 2(1): 84–87. Hendricks, M., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. Professional Psychology: Research and Practice, 43(5), 460-467. Herek (2008), Hate Crimes and Stigma-Related Experiences Among Sexual Minority Adults in the United States. Journal of Interpersonal Violence. Retrieved from: http://jiv.sagepub.com/content/early/2008/04/07/0886260508316477. full.pdf+html Herek et al (2009), Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56(1). Institute of Medicine [IOM]. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: The National Academies Press. Jiménez-Castaño, J., Cardona-Acevedo, M. & Sánchez-Muñoz, M. (2017). Discriminación y exclusión laboral en la comunidad LGBT: un estudio de caso en la localidad e Chapinero, Bogotá, Colombia. Recuperado de : https://www. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 47
redalyc.org/jatsRepo/112/11252977009/html/index.html Joint United Nations Programme on HIV/AIDS. Report on the Global AIDS Epidemic 2013. 2013. Available at: http://www. unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_ en.pdf. Accessed October 21, 2014. Google Scholar Kessler R.C., Barker P.R., Colpe L.J., Epstein J.F., Gfroerer J.C., Hiripi E., Howes M.J., Normand S.L., Manderscheid R.W., Walters E.E., Zaslavsky A.M. (2003). Screening for serious mental illness in the general population. Arch Gen Psychiatry, 60, 184 –189. Krueger, E. A., Lin, A., Kittle, K. R., & Meyer, I. H. (2015). Generations: Methodology and technical notes, Gallup quantitative survey (Version 15). Lemaitre-Ripoll, J. (2009). El amor en tiempos de cólera: Derechos LGBT en Colombia. SUR-Revista Internacional de Derechos Humanos, 6, 79-97. Madley-Dowd, P, Hughes, R, Tilling, K, Heron, J. 2019. The proportion of missing data should not be used to guide decisions on multiple imputation. Journal of Clinical Epidemiology 110: 63-73. Meyer, I. H. (2003). Prejudice, social stress and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697 Ministerio de la Protección Social y Fundación FES Social. Estudio Nacional de Salud Mental Colombia 2003 (2005). Disponible en: http://onsm.ces.edu.co/uploads/files/1243030_EstudioNacionalSM2003.pdf. Ministerio de Salud y Protección Social, 2018a. Plan Nacional De Respuesta Ante Las ITS, El VIH, La Coinfección TB/ VIH Y Las Hepatitis B Y C, Colombia, 2018-2021. Recuperado de: https://www.minsalud.gov.co/sites/rid/Lists/ BibliotecaDigital/RIDE/VS/PP/ET/plan-nal-respuesta-its-vih-coinfeccion-tbvih2018-2021.pdf Ministerio de Salud y de la Protección Social (2018b) Informe De Evento VIH7sida, Colombia, 2017 Disponible en: https:// www.ins.gov.co/buscador-eventos/Informesdeevento/VIH-SIDA%202017.pdf Mohr, J. J., & Kendra, M. S. (2011). Revision and extension of a multidimensional measure of sexual minority identity: the Lesbian, Gay, and Bisexual Identity Scale. Journal of Counseling Psychology, 58(2), 234–45. http://doi.org/10.1037/ a0022858 Moloney, A. (2018). Colombia failing to stem murders of LGBT people. Reuters. Accessed online 9/9/19: https://www. reuters.com/article/us-colombia-lgbt-murder/colombia-failing-to-stem-murders-of-lgbt-people-idUSKBN1JW21L Newport, F. (2018). In U.S., Estimate of LGBT Population Rises to 4.5%. Gallup. Retrieved from: https://news.gallup.com/ poll/234863/estimate-lgbt-population-rises.aspx Oettler, Anika. (2019). The Struggle for Gendered Peace and LGBT Rights in Colombia. Oficina de Información Diplomática del Ministerio de Asuntos Exteriores y de Cooperación ( 1 de mayo de 2017) Colombia República de Colombia. Recuperado de http://www.exteriores.gob.es/Documents/FichasPais/ COLOMBIA_FICHA%20PAIS.pdf Pineda Roa, C. (2015). Prevalencia y variables asociadas al consumo de sustancias psicoactivas en varones colombianos autoidentificados como homosexuales. Revista Iberoamericana de Psicología: Ciencia y Tecnología, 8(1), 83- 91 Pineda-Roa, C. (2019). Factores de Riesgo de ideación suicida en una muestra de adolescentes y jóvenes colombianod autoidentificacos como homosexuales. Recuperado de:https://reader.elsevier.com/reader/sd/pii/ S0034745017300720?token=1AD178096AA189101AC6F8240C1D015A7797E8A8B6 CAFCF32806C3D6BA027D21FCA43CFBDF38EE4CF06995F069ED09FF Pineda-Roa, C.A. y Navarro-Segura, M.C. (2019). Validación de una prueba para medir eventos vitales estresantes en adultos gay, lesbianas y bisexuales colombianos. Psicogente 22(41), 1-19. https://doi.org/10.17081/psico.22.41.3305 Rubin DB. Multiple imputation for nonresponse in surveys. New York: Wiley; 1987. Ruiz, A., Sepúlveda, M. A., Martínez, P. H., Muñoz, M. C., Mendoza, L. O., & Centanaro, O. P. Prevalence of sleep complaints in Colombia at different altitudes. Sleep Sci. 2016; 9 (2): 100-5. Sentiido & Colombia Diversa (2016). Encuesta Nacional sobre el Clima Escolar LGBT en Colombia. Mi voz cuenta, Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 48
Experiencias de Adolescentes y Jovenes, Lesbianas, Gays, Bisexuales y Trans en el ámbito escolar. Recuperado de: https://colombiadiversa.org/colombiadiversa2016/wp-content/uploads/2016/11/IAE-Colombia-Web-FINAL-2.pdf Sevelius, J. (2013). Gender affirmation: A framework for conceptualizing risk behavior among transgender women of color. Sex Roles, 68, (11-12), 675-689. Testa, R.J., Habarath, J., Peta, J., Balsam, K., & Bockting, W. (2015). Development of the Gender Minority Stress and Resilience Measure. Psychology of Sexual Orientation and Gender Diversity, 2(1), 65-77. The World Factbook (n.d.). https://www.cia.gov/library/publications/resources/the-world-factbook/. van Buuren, S. 2007. Multiple imputation of discrete and continuous data by fully conditional specification. Statistical Methods in Medical Research 16: 219–242. Zapata, L. (January 17th, 2019) El dolor de cabeza, ¿cefalea o migraña?. La crónica del Quindío. Recuperado de: https:// www.cronicadelquindio.com/el-dolor-de-cabeza-cefalea-o-migrana Zea, M.C., Reisen, C.A., del Río-González, A.M., Bianchi, F.T., Ramirez-Valles, J. & Poppen, P.J. 2015.HIV Prevalence and Awareness of Positive Serostatus Among Men Who Have Sex With Men and Transgender Women in Bogotá, Colombia American Journal of Public Health 105, 1588_1595, https://doi.org/10.2105/AJPH.2014.302307 Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 49
AUTHORS
This report was authored by the Colombia Collaborative Project. Authors include (listed alphabetically): Soon Kyu Choi, Shahrzad Divsalar, Jennifer Flórez-Donado, Krystal Kittle, Andy Lin, Ilan H. Meyer, and Prince Torres-Salazar.
ACKNOWLEDGMENTS This document was produced as part of the Lesbian, Gay, Bisexual, Transgender, and Intersex (LGBTI) Global Development Partnership. The Partnership was founded in 2012 and brings together the United States Agency for International Development (USAID), the Swedish International Development Cooperation Agency (Sida), the Arcus Foundation, the Astraea Lesbian Foundation for Justice, the National LGBT Chamber of Commerce (NGLCC), the LGBTQ Victory Institute, The Williams Institute at UCLA School of Law, Franklin and Marshall College, the Swedish Federation for LGBTQ Rights (RFSL), and other corporate, non-profit, and non-governmental organization resource partners.
The authors thank the following:
Study Recruitment team: Erick Mejía Puerta and Víctor Espinosa Jaimes (Coordinators), Daniela Montero Campo, Alenys Narváez Arrieta, Martha Gómez Hernández, Andrea Farah Mansour, Daniela Pérez Calvo, Fraid Palma Cuadrado, Gabriela Sandoval Gómez, Geraldine Pedraza Salcedo, Karen García C., Laura Manga García, Lina Suárez Fontalvo, María José Arrieta Romero, Luis Ricardo Niño Cárdenas, Silvia De Moya Durán, Xenia Flórez Mercado, Anailyn Cardona Fornaris, Sugey Ojeda, Gisella Bolívar Ripoll, Kiara Campo, Landines Yairy Quintero Navarrete, Javier Zambrano, Ale Niebles Márquez, Julieth Gómez Pacheco, Fabiana Ospino, Juan Camilo Allam Rivera, Natalia Petano, Estela Monterrosa
Report Reviewer: Amy Ritterbusch, Ph.D., Luskin School of Public Affairs, UCLA. Special thanks to the Colombian NGOs who participatd and helped disseminate our survey. Thanks to the volunteers from Colombia, México, Canadá, Estados Unidos, Australia, Italia, Líbano and Francia who joined to the project as ambassadors and supported and promoted the project spreading the goals. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 50
SUGGESTED CITATION The Colombia Colloborative.* (2019). Stress, Health, and Well-being of LGBT People in Colombia: Results from A National Survey. Los Angeles, CA: The Williams Institute.
The Colombia Collaborative Project authors include (listed alphabetically): Soon Kyu Choi, Shahrzad Divsalar, Jennifer Flórez-Donado, Krystal Kittle, Andy Lin, Ilan H. Meyer, and Prince Torres-Salaza
ABOUT THE WILLIAMS INSTITUTE
The Williams Institute is dedicated to conducting rigorous, independent research on sexual orientation and gender identity law and public policy. A think tank at UCLA Law, the Williams Institute produces high-quality research with real-world relevance and disseminates it to judges, legislators, policymakers, media and the public. These studies can be accessed at the Williams Institute website.
FOR MORE INFORMATION The Williams Institute, UCLA School of Law Box 951476, Los Angeles, CA 90095-1476 williamsinstitute.law.ucla.edu
RESEARCH THAT MATTERS Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 51
APPENDICES
APPENDIX 1: LEGAL STATUS OF LGBT PEOPLE IN COLOMBIA
LGBTQ-Interest Laws in Colombia
Authors: Kirsten Ryan, Andrés Cantero, Jr., Sean Cuddihy, & Peter Reichertz, (2018), Sheppard Mullin Richter & Hampton LLP
ISSUE COLOMBIA Criminal Law While domestic criminal legislation allows for heightened penalties for hate-motivated crimes, this tool is largely ignored by the courts. Prejudices that persist among judicial officers, judges, and prosecutors result in this aggravating factor not being applied in cases of homicides of LGBTQ persons, even when there is evidence for doing so. http://www.oas.org/en/iachr/reports/ Hate crime protections pdfs/Colombia-Truth-Justice-Reparation.pdf at 405. According to a 2015 report by the Inter-American Commission for Human Rights, in none of the 730 documented killings of LGBTQ persons between 2006 and 2014 did the court make a finding of aggravating circumstances based on the crime having been motivated by prejudice. http://www.oas.org/es/cidh/informes/pdfs/ ViolenciaPersonasLGBTI.pdf at 256. Crimes against LGBTQ individuals are often characterized as crimes of passion from early in the investigation phase, leading the investigators to overlook or minimize that the motive of the crime may have been the victim’s sexual orientation and/or gender identity. http://www.oas.org/en/iachr/reports/pdfs/ “Gay panic”/ “trans panic” Colombia-Truth-Justice-Reparation.pdf at 414. This also tends to be used to defense diminish the seriousness of the offense in sentencing and excuse the offender’s actions. See e.g. the mitigation of a sentence in the case of a killing of a gay man based on a defense of sudden “rage and intense pain” http://www.oas.org/en/ iachr/reports/pdfs/ViolenceLGBTIPersons.pdf at 252. Among the most vulnerable to violence and discrimination by police are transgender women who are human rights defenders and who also engage in sex work. One transgender human rights defender in Cali, Colombia, stated that Sex work prosecution the police “constantly ask us for identification when we’re working on the street, – gender expression as despite the fact that they know about our defense work or participate in cross- evidence agency meetings with us. For them it’s as if we stop being defenders when we are on the streets.” Because they engage in sex work on the street at night the police have greater opportunities “to take action against them with impunity.” http://www.oas.org/en/iachr/reports/pdfs/ViolenceLGBTIPersons.pdf at 183. “Same-sex couples showing public displays of affection are also a frequent Public sex/ lewdness laws target of police abuse and arbitrary detention by state agents – often with – reported patterns of excessive use of force or verbal abuse– because of what is considered “immoral selective enforcement behavior” in public spaces.” http://www.oas.org/en/iachr/reports/pdfs/ ViolenceLGBTIPersons.pdf at 79. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 52
ISSUE COLOMBIA In spite of a directive issued by the penitentiary authority in 2011, and several decisions of the Constitutional Court requiring trainings and sensitization programs aimed at guards and detainees regarding sexual orientation and gender identity in places of detention, the situation for LGBTQ prisoners is still dire. http://www.oas.org/en/iachr/reports/pdfs/ViolenceLGBTIPersons.pdf.
Torture and sexual violence are tolerated and even sometimes even perpetrated by guards. LGBTQ prisoners also do not get the care they need Protections for/ policies for treatment of HIV or related complications, as well as medications/tools to regarding LGBTQ prisoners assist with hormone therapy. Transgender prisoners are often classified by their biological sex/birth sex and not as the gender with which they identify. Transgender women are especially vulnerable to violence, sometimes being placed in solitary because there is nowhere else for them to go and no way to protect them. Conjugal visits (a documented right in Colombia) or expressions of affection with significant others during visitation are prohibited.http:// colombiadiversa.org/colombiadiversa2016/wp-content/uploads/2017/05/ INFORMECARCELES.pdf Civic Life The Justice Ministry issued a decree allowing the sex component on identity Gender markers on documents to be changed without medical or legal requirements. However, government IDs (note transgender people still need to be diagnosed with gender dysphoria by medical/surgical psychiatrists or the ruling of a judge to compel the health system to cover requirements and other any needed medical procedures to affirm their gender identity.http:// barriers) colombiadiversa.org/colombiadiversa2016/wp-content/uploads/2018/04/epu- colombia.pdf According to an abstract of Decision T-248-12 by the Constitutional Court of Colombia, the Higuera Clinical Laboratory prevented a gay man from donating blood because of his sexual orientation, citing Decree No. 1571 of 1993 that Public facilities (restrooms, “prohibited this to gays” (Colombia 26 Mar. 2012). The Court ruled in favor of schools, etc.) the plaintiff and ordered the clinic to implement a new survey and interview to identify risk factors for blood donations, “without taking into account the sexual orientation” of donors. http://www.refworld.org/docid/55924c3a4.html Violence against LBGTQ individuals remains a widespread social problem. In 2015, 110 homicides of LGBT people were documented. This is the highest number of homicides registered since 2012. Gay men and transgender people General social attitudes were the main victims of the homicides. At least 39 % of the homicides had (most recent polls; trends prejudice against sexual orientation or gender identity as the motive. See over time) http://colombiadiversa.org/ddhh-lgbt/EN/ [Highlights & graphics in English]; http://colombiadiversa.org/ddhh-lgbt/EN/Informe-Violencia-LGBT-Colombia- DDHH-2015.pdf [Full Report in Spanish] Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 53
ISSUE COLOMBIA Public Accommodations No accommodations-specific protections are in effect nationwide, but Colombia has passed Law 1482 of 2011, a general anti-discrimination law that includes sexual orientation as a prohibited ground of discrimination. It states that discriminatory acts directed at people because of gender and sexual orientation are criminal offenses that can be punished by imprisonment ranging from 12 to 36 months and a fine of 10 to 15 monthly legal minimum wages, unless Protection from the conduct constitutes an offense punishable by a heavier penalty.http:// discrimination – LGB www.refworld.org/docid/55924c3a4.html Additionally, as early at 1999 the Constitutional Court of Colombia established that sexual orientation cannot itself be considered a basis for punishment; thus legal provisions that “punish solely and exclusively those with that status” entail clear discrimination that promotes the stigmatization of LGBT persons. http://www.oas.org/en/iachr/ reports/pdfs/ViolenceLGBTIPersons.pdf at 52. Family Marriage and other unions In 2012, the Constitution Court issued a number of rulings providing that same- sex couples constitute a family for the purposes of succession benefits as well as pension rights. http://www.oas.org/en/iachr/reports/pdfs/Colombia-Truth- Probate Justice-Reparation.pdf at 404.
See links to and summaries of selected Constitutional Court opinions below this chart. Parenting Second-parent adoption, i.e., recognition of As of a ruling in 2015, same-sex couples can only adopt children if one parent same-gender partner of has a biological relation to the child. http://www.refworld.org/docid/55924c3a4. biological parent or other html existing legal guardian LGBTQ minors Conversion “therapy” bans No ban identified. Gender identity, gender expression and sexual orientation are one of the main reasons for discrimination against students in schools, and prevention, Bullying laws protection and complaint mechanisms do not work effectively.http:// colombiadiversa.org/colombiadiversa2016/wp-content/uploads/2018/04/epu- colombia.pdf The Constitutional Court has held that intersex children should decide themselves, via their free and informed consent, whether or not they want to undergo surgery, given the right “to free development of one’s personality, sexual identity and personal autonomy.” Among other recommendations, the Other minor-focused laws Court urged the Ministry of Health to “develop guidelines and official medical protocols” to effectively address the birth of intersex persons, including the mandatory establishment of a multidisciplinary team including a social worker and a psychologist to provide assistance to intersex persons and their families. http://www.oas.org/en/iachr/reports/pdfs/ViolenceLGBTIPersons.pdf at 234. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 54
ISSUE COLOMBIA Health Colombia recognizes a right to health under its Constitution. The current Colombian health care system was established in 1993 with the passage of Brief background on Law 100, which created a universal health insurance scheme divided into general health funding contributive and subsidized packages, both managed by highly regulated but system (e.g. single-payer) private companies. https://www.hhrjournal.org/2016/10/hiv-and-the-right-to- health-in-colombia/#sdendnote6sym Colombia recognizes a right to health, which has led to easier access for HIV+ individuals to get antiretroviral therapy, though it still remains relatively inaccessible to sex workers. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5395009/
Coverage for HIV/AIDS treatment The first tutela (civil rights filing) to claim a violation of the right to health was T-484 of 1992, brought by a person living with HIV whose medication had been suspended by the public insurer Seguro Social de Tuluá. https://www.ncbi.nlm. nih.gov/pmc/articles/PMC5395009/ [English Discussion]
http://www.corteconstitucional.gov.co/relatoria/1992/T-484-92.htm [Decision in Spanish] In 2014, the Colombian Ministry of Health launched needle and syringe programs for distribution to intravenous drug users to help reduce transmission of HIV and Hepatitis. https://colombiareports.com/colombia- Needle exchange and announces-needle-exchange-program/ other harm reduction programs Colombia has also instituted some limited opioid substitution therapy treatment centers to help heroin users get sober. https://www.avert.org/ professionals/hiv-around-world/latin-america/overview#footnote68_rhx5ysx
Colombia Case Examples
Public Benefits & Governmental Recognition of Same-Sex Unions
Sentencia C-075/07, Constitutional Court of Colombia (7 February 2007) — Full Spanish Text of Decision In this case, the Court recognized that same sex couples had the right to form a common law marriage. Specifically, the Court concluded that denying same-sex partners the same inheritance protections and rights that were granted to heterosexual civil unions was unconstitutional, though four justices in the majority wrote separately to clarify that constitutional protection for same-sex civil unions did not mean that such unions were considered families under Article 42 of the Constitution.
Sentencia C-029/09, Constitutional Court of Colombia (28 January 2009) — Full Spanish Text of Decision The Court held that people in civil unions, whether heterosexual or homosexual, were entitled to a minimum level of protection, without which their rights to human dignity and free personal development would be compromised. Thus, same-sex couples must be extended all of the rights Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 55
offered to cohabitating heterosexual couples. The Court further held that the following rights should be extended to same-sex civil unions: marital civil rights, immigration benefits, testimonial privilege, guardianship and conservatorship, civil protections for partners in cases of disappearances or kidnappings, health care, retirement and pension benefits for partners of law enforcement officers, all family subsidies that had previously been extended only to opposite-sex civil partners, and all housing allowances that had previously been extended only to opposite-sex civil partners. The Court also concluded that gender-specific terms in the challenged laws should be replaced by gender- neutral terms.
Sentencia T-283/11 — Full Spanish Text of Decision In this decision, the Constitutional Court repeated its case law regarding to the difference between de facto marital unions and marriage. However, the Court stated that the fact that they are not equal bonds, does not mean that the same rights, guarantees and burdens can be granted by the legislator to the members of either one union or the other, particularly, in relation to marital property, since the two unions are based on a decision taken freely by individuals to live together with a spirit of staying together. On this basis, the Court concluded that there was no valid reason to state that protection of marital property cannot be also granted to the surviving permanent spouse, who— without having formalized his/her relationship—constructed a common life project, and showed solidarity and provided care and support, just as a spouse does. The Court questioned the award of a marital portion of an estate because it was only granted to someone who had a marriage bond. In this sense, the Court warned that to be entitled to the marital portion, you must prove through evidence that you are the surviving spouse, that is, the two years of cohabitation required by Law No. 50 /94, as amended by Law No. 979 /05. The Court urged Congress to legislate in a systematic and orderly manner on de facto marital unions and same-sex couples, in such a way that in the future there are legal solutions to solve the varied disputes and claims that may arise from the recognition of rights carried out by the Court.
Sentencia C-577/11 — Full Spanish Text of Decision The Constitutional Court declared that homosexuals have the right to form a family and asked Congress to make a law about gay marriage within two years. Otherwise, the Court provided that homosexual couples may go before a Notary in order to legalize their union. The ruling held that the phrase “man and woman” in the definition of marriage is in conformity with the Colombian Constitution, but the justices were of the view that such phrase does not imply a prohibition against a legal bond between homosexuals, similar or equal to that of heterosexual couples.
Sentencia C-238/12, Constitutional Court of Colombia (4 May 2012) — Full Spanish Text of Decision The Court granted survivor pension rights for same-sex partners, based on its prior reasoning in Sentencia T-716/11 and Sentencia C-029/09.
Sentencia SU-214/16 — Full Spanish Text of Decision This case was consolidated from several cases related to the recognition of same-sex marriages by judges and notaries. The Court found that civil marriage between same sex couples is a legitimate and valid way to materialize the constitutional principles and values, and a form to ensure the effectiveness of the right to conform a family and the human dignity, regardless sexual orientation or gender identity. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 56
Adoption
Sentencia T-276/12, Constitutional Court of Colombia (11 April 2012) — Full Spanish Text of Decision After successfully complying with an international adoption process, a gay American man’s adoption of two Colombian brothers was terminated when the agency discovered his sexual orientation. The Constitutional Court found a violation of the fundamental rights of equality, free development of personality, and due process, as well as the right of the child to have a family, to be free from discrimination on the basis of family, and to be heard and reinstated in the custody of the adoptive father.
Sentencia SU-617/14 — Full Spanish Text of Decision The Constitutional Court found a right of homosexual couples to adopt the biological child of one of the partners, overturning precedent. The Court found that the administrative authority precluding adoption on the basis of the homosexual nature of the applicant couples violates the rights of all to family autonomy, and that there is no justification to preclude official recognition of a family arrangement in which the child, by the will of its biological parent, shares life with a partner or same- sex partner of that parent, and in which a strong and stable bond between them is formed, and from which the adult has assumed the duties and obligations associated with the filial bond.
Intersex/Gender-Conforming Medical Procedures
Sentencia SU 337/99, Constitutional Court of Colombia (12 May 1999) — Full Spanish Text of Decision In the case of an eight-year-old intersex child, the court had to determine whether requiring the mature consent of the plaintiff’s child to perform genital-conforming surgery violated the right to equal treatment, freedom of personal development, and the protection of childhood. Because the child was older and had already developed a female gender identity, the Court found that denying immediate access to surgery was not a grave compromise of her right to life and therefore the mother could not authorize surgery or hormone treatment. Any invasive medical procedures could only occur with the child’s informed consent. If a medical team found her to be sufficiently autonomous to provide informed consent, she could have surgery before the age of majority. If not, then she would need to wait until reaching the age of majority.
Sentencia T-912/08, Constitutional Court of Colombia (18 December 2008) — Full Spanish Text of Decision Plaintiff’s five year old child was identified as having both male and female genitalia, and parents wanted him to have surgery to conform with the gender he was raised (male). The Court required the defendants to form a medical team consisting of surgeons, urologists, endocrinologists, pediatricians, psychiatrists, therapists, and social workers to assist the child and the parents to understand the surgery and its implications. If, after the parents and child had been fully informed of the medical findings, the complications and risks of surgery, and potential future issues as well as alternative medical and non-medical options, and the medical team agreed with their decision, the defendants were mandated to perform surgery. Specifically, the Court considered it important to ascertain whether the child truly identified with the gender desired by the parents. However, if the child’s decision did not match that of the parents, or the medical team did not agree with the decision of the child and parents, no surgery could be performed until the child was eighteen and able to make his or her own informed decision. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 57
Gender on Identifying Documents
Sentencia T-498/17 — Full Spanish Text of Decision The Court held that in Colombia any Colombian is allowed to request a change of sex in a Notary Office and that this will be registered on their ID.
Sentencia T-675/17 — Full Spanish Text of Decision This case has to do with changing the sex markers on the identity cards of intersex children. The Court considered that if children can make decisions as irreversible as a surgery for sex change or abortion, why not do it on the change of an identity document, which in any case is a procedure that can be modified after 10 years. For this reason the ruling decided to allow young people make these decisions in protection of their rights to the free development of their personality, equality and personal autonomy, provided that the following requirements are met: (1) there must be a clear free manifestation and informed by the child; (2) that the child is close to turning 18 years of age, and (3) it must be proven through medical concepts that the child is in the process of implementing a gender transition.
Homosexuality in the Military
Sentencia C-507/99, Constitutional Court of Colombia (14 July 1999) — Full Spanish Text of Decision Court was asked whether it was lawful to discipline soldiers on active duty on the grounds that they lived in concubinage or adultery, associated with “anti-social” elements such as homosexuals or prostitutes, or practiced homosexuality or prostitution (Military Decree 85 of 1989, Article 184). The Court found that (1) the prohibition of living together outside of marriage violated Article 42 of the Constitution, (2) neither the State nor society were entitled to interfere with the development of an individual’s sexual identity, (3) the categorization of homosexuals and prostitutes as anti-social was unconstitutional, and (4) the condemnation of private homosexual acts as offences against military honor, unconstitutionally stigmatized homosexuals. However, the Court did recognize that this protection of acts performed in private life did not cover sexual acts (whether homosexual or heterosexual) carried out in public or while on duty or within military premises and that the military could prohibit such public acts.
Homosexuality in Teaching Profession
Sentencia C-481/98, Constitutional Court of Colombia (9 September 1998) — Full Spanish Text of Decision The Court found that Article 46 of Decree 2277, which categorized homosexuality as a ground of misconduct in the teaching profession, violated the right to privacy, the right to free personal development, the right to work, and the right to equality under the Colombian Constitution.
Protection of the rights of sex workers
Sentencia T- 629/10 — Full Spanish Text of Decision This decision requires labor protection for sex workers regarding their right to motherhood and non- discrimination based on gender and equal pay, just like those in place for any other occupation.
Sentencia T-594/16 — Full Spanish Text of Decision In this ruling, the Court protected the fundamental rights of two women to free movement, personal Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 58
freedom and non-discrimination for their activity as sex workers. The Court also reaffirmed that prostitution is not a crime and that sexual services cannot be equated to the sale of an object.
Bullying/Harassment in Schools
Sentencia T-478/15 — Full Spanish Text of Decision This case arose out of the death of Sergio Urrego. Sergio Urrego Reyes was a gay young man who took his own life after suffering bullying and harassment by school officials, who accused him of sexual harassment and committing a fault in the school’s Coexistence Manual (which stated that homosexuality was forbidden) for having kissed a partner, with whom he had an emotional relationship. The Court concluded that at the Castillo Campestre Gymnasium, Urrego was subjected to an irregular disciplinary process, which constituted discrimination and school bullying, which could have affected the decision he made to commit suicide. The Constitutional Court issued a ruling that protected the rights to privacy, good name, equality, non-discrimination, the free development of personality, education and due process of young Sergio Urrego.
LGBT Prisoner’s Rights
Sentencia T-372/13 — Full Spanish Text of Decision In this decision, the Colombian Constitutional Court established the right to conjugal visits for LGBT prisoners based on the right to privacy, free development of personality and non-discrimination by reason of sex. The Court ordered a prison Director to allow regular conjugal visits for two lesbian women.
Sentencia T-062/11 — Full Spanish Text of Decision This decision by the Constitutional Court laid out the rights of LGBT persons deprived of liberty (aka prisoners). These included mandating trainings and sensitization programs aimed at guards and detainees regarding sexual orientation and gender identity in places of detention, imposing monitoring and reporting mechanisms, and requiring the cessation of practices that infringe on the rights of LGBT prisoners.
Non-Discrimination in Blood Donations
Sentencia T-248/12 — Full Spanish Text of Decision The plaintiff in this case tried to donate blood at Higuera Clinical Laboratory, but was rejected after disclosing he was gay as was required by Decree No. 1571 of 1993 which prohibited blood donations by gay men. The Court concluded that the behavior of the laboratory when it discarded the donor because of his sexual orientation, and not on the grounds of risky sexual practices, constituted a discriminatory treatment which infringes fundamental rights. The Court ordered the Higuera Clinical Laboratory to implement a new survey and interview aimed at identifying the risk factors for blood donations, but without taking into account sexual orientation. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 59
APPENDIX 2: STUDY QUESTIONNAIRE IN SPANISH
SCREENER
QUESTION # SCREENER ELIGIBILITY
¿Cuál de estas opciones te describe mejor a ti mismo? Lesbian Gay s_1 Bisexual Transgénero Ninguna de éstas, es decir, heterosexual Algo más (Escríbelo aquí):
¿Cuál de estas opciones es la que mejor te describe? Ni gay ni lesbiana, es decir, heterosexual If s_sexid = a, not eligible s_sexid Lesbiana If s_sexid = b, c, d, e = eligible Gay Bisexual If s_sexid = eligible, 2 and 3 = any response, eligible.
If s_sexid= not eligible and ¿Qué sexo te fue asignado al nacer en tu certificado 2 = a and 3 = a, not eligible original de nacimiento? s_sexatbirth Femenino If s_sexid = not eligible and Masculino If s_sexatbirth = b and 3 = b, not eligible
If s_sexid = not eligible and s_sexatbirth = a and s_ genderid = b, eligible
If s_sexid = not eligible and If s_sexatbirth = b and s_ genderid = a, eligible ¿Cuál de los siguientes términos describe mejor tu actual identidad de género? If s_sexid = not eligible and Mujer s_sexatbirth = a or b, and s_genderid Hombre s_genderid = c, or d eligible Mujer Trans (de hombre-a-mujer) Hombre Trans (de mujer-a-hombre) If s_sexid=not eligible, and No binario (ni hombre/ni mujer, “genderqueer”) s_sexatbirth=a or b, and s_genderid=e, not eligible, but will take the demographic questions Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 60
QUESTION # SCREENER ELIGIBILITY
¿En qué año naciste? If s_yearborn> 2001, not eligible s_yearborn If s_yearborn = 2001 or less, eligible
¿Cuál es tu nivel más alto de educación? No fui a la escuela/colegio Terminé primer grado de primaria- 1st Terminé segundo grado de primaria – 2nd Terminé tercer grado de primaria - 3rd grade If 4th grade or less, not eligible s_educlevel Terminé cuarto grado de primaria – 4th grade If 5th grade or more, eligible Terminé quinto grado de primaria – 5th grade Secundaria/bachillerato Técnico/tecnológico Universitario Postgrados
¿ Dónde vives? Barranquilla Bogotá Cartagena If s_residence = g), not eligible s_residence Medellín If s_residence= a)-f), eligible Soledad Otro lugar en Colombia______Fuera de Colombia
CUESTIONARIO
SOLO SI USTED SE IDENTIFICA COMO LGB
Para cada una de las siguientes preguntas, por favor marque la respuesta que mejor indique su experiencia actual como lesbiana, gay o bisexual (LGB). Usamos “LGB”, genéricamente, para referirnos a la identidad de una minoría sexual con la que usted se identifique. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 61
TOTALMENTE EN ALGO DE ALGO DE TOTALMENTE EN DE ACUERDO DESACUERDO DESACUERDO ACUERDO DE ACUERDO DESACUERDO
1. Mi orientación sexual es una parte insignificante de quien soy yo…
2. Mi orientación sexual es una parte central de mi identidad………………..
3. Para entender quién soy comopersona, debes saber que soy LGB…
4. Ser una persona LGB es un aspectomuy importante de mi vida…………..
5. Creo que ser LGB es una parte importante de mí…………………………
A continuación hay algunas preguntas acerca de su crecimiento y sus sentimientos sexuales de cuando usted era más joven. Nuevamente le recordamos, que por “LGB”, nos referimos a la identidad de la minoría sexual con la que usted se identifique.
6. ¿A qué edad, se sintió sexualmente atraído, por primera vez, por alguien de su mismo sexo?
Edad
Nunca me he sentido atraído por alguien del mismo sexo No sé/No recuerdo
7. ¿A qué edad tuvo, por primera vez, sexo con alguien de su mismo sexo con su consentimiento?
Edad
Nunca he tenido sexo con consentimiento con alguien del mismo sexo No sé/No recuerdo Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 62
8. ¿A qué edad tuvo su primera relación íntima con alguien del mismo sexo, donde ambos se sintieran enamorados o románticamente involucrados?
Edad
Nunca he tenido relación íntima con alguien del mismo sexo, donde ambos nos sintiéramos enamorados o románticamente involucrados No sé/No recuerdo
9. ¿A qué edad se dio cuenta usted, por primera vez, que era LGB?
Edad
Nunca me di cuenta de que yo era LGB No sé/No recuerdo
10. ¿A qué edad le dijo, por primera vez, a un amigo heterosexual que usted era LGB?
Edad
Nunca le dije a un amigo heterosexual que yo era LGB No sé/No recuerdo
11. ¿A qué edad le dijo, por primera vez, a un miembro de su familia que usted era LGB?
Edad
Nunca le he dicho a nadie de mi familia que soy LGB No sé/No recuerdo
12. ¿Qué edad tenía cuando se hizo evidente para usted que alguien en su familia se había dado cuenta de que era LGB antes de usted haberle dicho?
Edad
Nunca se hizo evidente para mí que alguien en mi familia se hubiera dado cuenta de que yo era LGB antes de yo decirle. No sé/No recuerdo Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 63
13. Ahora recuerde cuando estaba en la secundaria/bachillerato, ¿cuán “fuera del closet” estaba usted?
Fuera del closet para todos en el colegio Fuera del closet para la mayoría del colegio Fuera del closet para algunos del colegio Fuera del closet para pocos en el colegio Fuera del closet para ninguno del colegio
SOLO SI USTED SE IDENTIFICA COMO TRANS
14. ¿A qué edad comenzó a sentir que su género era “diferente” al que le asignaron en su nacimiento?
Edad
Nunca me he sentido así No sé / No lo recuerdo
15. ¿A qué edad empezaste a pensar que eras transgénero (incluso si no sabías la palabra)?
Edad
Nunca he pensado eso No sé / No lo recuerdo
16. ¿Aproximadamente a qué edad empezaste a decirle a los demás que eras transgénero (incluso si no usabas esa palabra)?
Edad
No les he dicho a otros que soy transgénero No sé / No lo recuerdo Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 64
TODO EL MUNDOLAS SIGUIENTES PREGUNTAS SON SOBRE CÓMO USTED SE SIENTE EN LA COMUNIDAD LGBT. POR FAVOR CALIFIQUE LOS SIGUIENTES ÍTEMS SEGÚN SU GRADO DE ACUERDO.
TOTALMENTE TOTALMENTE EN DE ACUERDO EN DE ACUERDO DESACUERDO DESACUERDO 17. Usted siente que es parte de la comunidad LGBT………………………….. 18. Participar en la comunidad LGBT es algo positivo para usted…………… 19. Siente un vínculo con la comunidad LGBT………………………….. 20. Está orgulloso de la comunidad LGBT………………………… 21. Es importante para usted ser activista en la comunidad LGBT…. 22. Si trabajaramos juntos, lesbianas, gays, bisexuales y transgéneros podríamos resolver los problemas de la comunidad LGBT…………………………. 23. Realmente piensa que los problemas enfrentados por la comunidad LGBT, son también sus propios problemas………………………….
Las siguientes preguntas son sobre su salud.
24. En general, diría que su salud es…
Excelente Muy buena Buena Regular Mala Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 65
25. Respecto a su salud física, incluyendo enfermedades y lesiones físicas, en los últimos 30 días ¿por cuantos días su salud física no fue buena?
días
Ninguno
26. Ahora, piense en su salud mental; incluyendo estrés, depresión y problemas emocionales. En los últimos 30 días, ¿por cuantos días su salud mental no fue buena?
días
Ninguno
27. En los ultimso 30 días, ¿por cuántos días, la mala salud física o mental, le impidieron realizar sus actividades habituales como cuidados personales, trabajo o actividades recreativas?
días
Ninguno
28. ¿ALGUNA VEZ un médico, enfermero u otro profesional de la salud, le dijo a usted que tenía alguna de las siguientes afecciones? Por favor seleccione todas las que para su caso aplique.
Hipertensión (presión alta) Colesterol alto Enfermedad cardíaca o condición cardíaca Angina Infarto Isquemia cerebral o infarto cerebral Enfisema Asma Ulcera Cáncer Diabetes Prediabetes, glucosa alterada en ayunas, intolerancia a la glucosa, diabetes límite o altos níveles de azúcar en la sangre Artritis, artritis reumatoidea, gota, lupus o fibromialgia Coágulos de sangre en piernas o pulmones Osteoporosis o pérdida de densidad ósea Problemas de Tiroide Enfermedad del hígado Enfermedad Pulmonar Obstructiva Crónica (EPOC) Enfermedad de Crohn o colitis ulcerosa Enfermedad del riñón Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 66
VIH/SIDA Otra infección de transmisión sexual (sin incluir el VIH/SIDA) Trastorno del sueño (por ejemplo, insomnio o apnea del sueño) Ninguna de la anteriores
Las siguientes preguntas son sobre cómo te has sentido en los últimos 30 días. Para cada pregunta, escoja cada cuánto tiene ese sentimiento.
29. Durante los últimos 30 días, más o menos, con qué frecuencia se ha sentido…
TODO EL LA MAYORÍA ALGO DE MUY POCO NADA DE TIEMPO DEL TIEMPO TIEMPO TIEMPO TIEMPO
a. Nervioso (a)
b. Desesperanzado (a)
c. Inquieto (a) o intranquilo (a) d. Deprimido (a), que nada le podía levantar el ánimo e. Que todo costaba mucho trabajo
f. Que nada valía la pena
Las siguientes preguntas son sobre alcohol y drogas.
30. ¿Con qué frecuencia toma usted una bebida que contenga alcohol?
Nunca Mensualmente o menos 2 ó 4 veces al mes 2 ó 3 veces a la semana 4 ó más veces a la semana
31. ¿Cuántas bebidas que contengan alcohol se toma usted en un día normal cuando bebe?
Ninguna 1 ó 2 3 ó 4 5 ó 6 7 a 9 10 más Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 67
32. ¿Con qué frecuencia toma usted seis o más tragos en una ocasión?
Nunca Menos que mensualmente Mensualmente Semanalmente Diariamente o casi diariamente A continuación, tenemos algunas preguntas sobre las drogas. Responda de la manera más correcta y honesta posible indicando cuál es la respuesta adecuada para usted. Para las siguientes preguntas, hacemos referencia a drogas como marihuana, metanfetamina, crack, heroína, éxtasis, GHB y píldoras, como pastillas para dormir y analgésicos. No cuentan como drogas si los ha recetado un médico y las toma con la dosis prescrita.
33. ¿Con qué frecuencia consume drogas distintas al alcohol?
Nunca Una vez al mes o menos De 2 a 4 veces al mes De 2 a 3 veces al mes 4 o más veces a la semana
34. ¿Consume más de un tipo de droga en una misma ocasión?
Nunca Una vez al mes o menos De 2 a 4 veces al mes De 2 a 3 veces al mes 4 o más veces a la semana
35. En un día normal en el que consume drogas, ¿cuántas veces lo hace?
0 1-2 3-4 5-6 7 o más
36. ¿Con qué frecuencia se encuentra usted bajo el efecto intenso de las drogas?
Nunca Menos de una vez al mes Todos los meses Todas las semanas A diario o casi a diario Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 68
37. En el último año, ¿ha sentido que su deseo por consumir drogas era tan fuerte que no podía resistirlo?
Nunca Menos de una vez al mes Todos los meses Todas las semanas A diario o casi a diario
38. ¿Le ha ocurrido en el último año que no ha podido parar de consumir drogas una vez que había empezado a consumirlas?
Nunca Menos de una vez al mes Todos los meses Todas las semanas A diario o casi a diario
39. ¿Con qué frecuencia en el último año ha consumido drogas y luego ha dejado de hacer algo que debería haber hecho?
Nunca Menos de una vez al mes Todos los meses Todas las semanas A diario o casi a diario
40. ¿Con qué frecuencia en el último año ha necesitado consumir una droga, la mañana siguiente a un día de mucho consumo?
Nunca Menos de una vez al mes Todos los meses Todas las semanas A diario o casi a diario
41. ¿Con qué frecuencia en el último año ha tenido sentimientos de culpa o remordimientos por haber consumido drogas?
Nunca Menos de una vez al mes Todos los meses Todas las semanas A diario o casi a diario Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 69
42. ¿Usted o alguna otra persona ha sufrido daños (mentales o físicos) porque usted había consumido drogas?
No Sí, pero no en el último año Sí, en el último año
43. ¿Algún familiar o amigo, médico o enfermera, o cualquier otra persona, ha mostrado preocupación sobre su consumo de drogas o le ha dicho que debería dejar de consumir?
No Sí, pero no en el último año Sí, en el último año
44. ¿ Alguna vez en su vida ha tenido pensamietos sobre suicidarse?
No Si
45. ¿Alguna vez tuvo la intención de actuar sobre pensamientos de haber deseado estar muerto o de intentar suicidarse?
No Si
46. ¿Alguna vez pensó en cómo podría suicidarse (por ejemplo, tomando píldoras, disparándose usted mismo) o ha ideado un plan para suicidarse?
No Si
47. ¿Alguna vez intentó suicidarse (es decir, que se hirió a propósito con al menos alguna intención de morir)?
No pasa a la 49 Si Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 70
48. ¿Cuáles fueron las lesiones más graves que usted tuvo de un intento de suicidio?
No tuve lesiones Una lesión muy leve (por ejemplo, arañazos superficiales, náuseas leves) Lesiones menores (por ejemplo, esguince, quemaduras de primer grado, heridas superficiales) Lesiones moderadas que no requirieron hospitalización durante la noche (por ejemplo, huesos rotos, quemaduras de segundo grado, puntos de sutura, bala alojada en un brazo o pierna) Lesiones moderadas que requirieron hospitalización durante la noche (por ejemplo, factura mayor, quemaduras de tercer grado, coma, bala alojada en el abdomen o el tórax, cirugía menor) Lesiones graves que requirieron tratamiento en una unidad de cuidados intensivos para salvar vidas (por ejemplo, fractura importante de cráneo o columna vertebral, quemaduras graves, coma que requirió respirador, bala en la cabeza, cirugía mayor)
49. ¿Alguna vez hizo algo para lastimarse a propósito, pero sin querer morir (por ejemplo, cortarse, golpearse a sí mismo o quemarse)?
No Si
SOLO SI USTED SE IDENTIFICA COMO LGB
La siguiente sección trata de experiencias que pueden haberle sucedido a lo largo de su vida. Las primeras preguntas son sobre cuánto usted está fuera del closet para los siguientes grupos de personas. Usamos “LGB” genéricamente para referirnos a la identidad de la minoría sexual con la que usted se identifica.
50. ¿Está fuera del closet para todos, para la mayoría, para algunos o para ninguno de los siguientes grupos de personas…
NO SÉ/ TODO MAYORÍA ALGUNOS NINGUNO NO APLICA Familia Amigos heterosexuales Compañeros de trabajo Gente de los Servicios de salud como, por ejemplo médicos, enfermeros, psicólogos, etcétera Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 71
SOLO SI USTED SE IDENTIFICA COMO TRANSGÉNERO
Por favor califique su grado de acuerdo en los siguientes ítems.
51. Porque no quiero que otros conozcan mi identidad de género/historia...
NI DE TOTALMENTE TOTALMENTE DESACUERDO ACUERDO NI DE ACUERDO DESACUERDO DE ACUERDO DESACUERDO A. No hablo de ciertas experiencias de mi pasado o cambio partes de lo que les diré a las personas B. Modifico mi forma de hablar C. Presto especial atención a la forma en que me visto o arreglo. D. Evito exponer mi cuerpo, como usar un traje de baño o desnudarme en los vestuarios.
E. Cambio la forma en que camino, gesticulo, me siento o me paro
52. ¿Con qué frecuencia la gente puede decir que usted es LGB o transgénero, incluso si usted no les dice?
Siempre La mayoría de las veces Algunas veces Ocasionalmente Nunca Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 72
SOLO SI USTED SE IDENTIFICA COMO LGB
A continuación, se incluyen declaraciones que representan cómo usted piensa que las personas NO LGBT pueden pensar sobre las personas LGB. Por favor califique los siguientes ítems según su grado de acuerdo.
NI DE TOTALMENTE EN ACUERDO ALGO DE TOTALMENTE EN DESACUERDO NI EN ACUERDO DE ACUERDO DESACUERDO DESACUERDO 53. La mayoría de las personas donde vivo piensan que los LGB son menos que las demás personas 54. La mayoría de los empleadores donde vivo contratarían abiertamente a personas LGB si están calificados para el trabajo. 55. La mayoría de las personas donde vivo no querrían que alguien que abiertamente sea LGB se ocupe de sus hijos
SOLO SI USTED SE IDENTIFICA COMO LGB
Las siguientes preguntas son sobre cómo se siente acerca de ser LGB. Por favor califique lo siguiente según su grado de acuerdo. Nuevamente le decimos que por “LGB” nos referimos a la identidad de la minoría sexual con la que usted se identifica.
NI DE TOTALMENTE EN ACUERDO ALGO DE TOTALMENTE EN DESACUERDO NI EN ACUERDO DE ACUERDO DESACUERDO DESACUERDO 56. Intenté dejar de sentirme atraído por personas de mí mismo sexo
57. Si alguien me ofreciera la oportunidad de ser completamente heterosexual, aceptaría la oportunidad
58. Desearía no ser LGB Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 73
59. Siento que ser LGB es una deficiencia personal para mí
60. Me gustaría obtener ayuda profesional para cambiar mí orientación sexual de LGB a heterosexual
SOLO SI USTED SE IDENTIFICA COMO TRANSGÉNERO
61. Por favor califique su grado de acuerdo en los siguientes ítems.
NI DE TOTALMENTE TOTALMENTE DESACUERDO ACUERDO NI DE ACUERDO DESACUERDO DE ACUERDO DESACUERDO A. Odio mi identidad de género B. Ser transgénero me hace sentir como un fenómeno C. Me siento como un marginado por ser transgénero D. Me pregunto ¿por qué no puedo ser normal? E. Siento que ser transgénero es ver- gonzoso F. Envidio a la gente que no es trans- género
SOLO SI USTED SE IDENTIFICA COMO LGB
62. ¿Alguna vez recibió tratamiento de alguien que intentó cambiar su orientación sexual (como tratar de volverse heterosexual)? En caso afirmativo, marque todos los recuadros que correspondan.
No Si, de un profesional de la salud (como un psicólogo o un consejero sin énfasis religioso) Si, de un líder religioso (como un pastor, un consejero religioso, un sacerdote) Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 74
SOLO SI USTED SE IDENTIFICA COMO TRANSGÉNERO
63. ¿Alguna vez recibió tratamiento de alguien que intentó hacerle identificarse solo con su sexo asignado al nacer (en otras palabras, tratar de evitar que usted fuera transgénero)? En caso afirmativo, marque todas las casillas que correspondan.
No Sí, de un profesional de la salud (como un psicólogo o un consejero que no estaba enfocado en la religión) Si, de un líder religioso (como un pastor, un consejero religioso, un sacerdote)
TODO EL MUNDO
Las siguientes declaraciones son sobre sus experiencias de vida y las cosas que le pudieron haber sucedido. Este es un tema sensible y algunas personas pueden sentirse incómodas con estas preguntas.
64. Desde la edad de 18 años, ¿con qué frecuencia le ha sucedido algo de lo siguiente?
NUNCA UNA VEZ DOS VECES TRES O MÁS VECES A. Fue golpeado, atacado físicamente (Skip to C, if answered Nunca) B. Fue esto causado por grupos armados al margen de la ley (como guerrillas y paramilitares, entre otros)? � Si � No C. Fue agredido sexualmente (Skip to E, if answered Nunca)
D. ¿Fue esto causado por grupos armados al margen de la ley (como guerrillas y paramilitares, entre otros)? � Si � No E. Fue robado, o su propiedad fue asaltada, vandalizada o dañada intencionalmente. (Skip to G, if answered Nunca) F. ¿Fue esto causado por grupos armados al margen de la ley (como guerrillas y paramilitares, entre otros)? � Si � No G. Alguien intentó atacarlo, robarlo o dañarle su propiedad, pero no tuvo éxito (Skip to I, if answered Nunca) Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 75
NUNCA UNA VEZ DOS VECES TRES O MÁS VECES H. ¿Fue esto causado por grupos armados al margen de la ley (como guerrillas y paramilitares, entre otros)? � Si � No I. Alguien lo amenazó con violencia (Skip to K, if answered Nunca) J. ¿Fue esto causado por grupos armados al margen de la ley (como guerrillas y paramilitares, entre otros)? � Si � No K. Alguien lo insultó o agredió verbalmente (Skip to M, if answered Nunca) L. ¿Fue esto causado por grupos armados al margen de la ley (como guerrillas y paramilitares, entre otros)? � Si � No M. Alguien le arrojó un objeto (Skip to 65, if answered Nunca) N. ¿Fue esto causado por grupos armados al margen de la ley (como guerrillas y paramilitares, entre otros)? � Si � No
Las siguientes preguntas son acerca de tu experiencia con la policia.
65. En el último año, ¿qué tan seguido la policía o las aplicaciones de la ley han sido verbalmente abusivos contigo?
Nunca Una vez Dos veces Tres o más veces
66. En el último año, ¿qué tan seguido la policía o las aplicaciones de la ley han sido físicamente abusivos contigo?
Nunca Una vez Dos veces Tres o más veces Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 76
Las siguientes preguntas son sobre como has sido tratado por los demás.
67. Desde la edad de 18 años, ¿con qué frecuencia fue despedido de su trabajo o le negaron un trabajo?
Nunca Una vez Dos veces Tres o más veces
68. Desde la edad de 18 años, ¿con qué frecuencia se le negó un ascenso o recibió una evaluación negativa?
Nunca Una vez Dos veces Tres o más veces
69. Desde la edad de 18 años, ¿con qué frecuencia un propietario o una agencia de bienes raíces le impidió mudarse o comprar una casa o apartamento?
Nunca Una vez Dos veces Tres o más veces
70. En su día a día cotidiano, durante el último año, ¿Qué tan seguido le ha pasado alguna de las siguientes situaciones?
ALGUNAS A MENUDO RARA VEZ NUNCA VECES
A. Le han tratado con menos cortesía que a otros B. Le han tratado con menos respeto que a otros C. Ha recibido peor servicio que otros estando en restaurantes o almacenes D. La gente ha actuado como si pensara que usted no es inteligente E. La gente ha actuado como si le tuvieran miedo a usted F. La gente ha actuado como si pensara que usted es deshonesto G. La gente ha actuado como si fuera mejor que usted Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 77
H. Le llamaron por apodos ofensivos o lo insultaron
I. Le han amenazado-acosado
Las siguientes preguntas son sobre sus experiencias de la niñez.
71. De niño/a, mis juguetes favoritos eran…
Siempre “masculinos” Usualmente “masculinos” Igualmente “masculinos” y “femeninos” Usualmente “femeninos” Siempre “femeninos” Ni “masculinos” ni “femeninos”
72. De niño/a, los personajes de televisión o de películas que imitaba y admiraba eran….
Siempre niños u hombres Usualmente niños y hombres Mujeres/niñas y hombres/niños por igual Usualmente niñas/mujeres Siempre niñas/mujeres No imitaba ni admiraba a ningún personaje de televisión ni de películas
73. En los juegos de roles, tomaba el de….
Solo hombres y niños Usualmente hombres y niños Mujeres/niñas y hombres/niños por igual Usualmente niñas/mujeres Siempre niñas/mujeres No jugaba este tipo de juegos
74. De niño/a me sentía….
Muy masculino/a Algo masculino/a Masculino/a y femenino/a por igual Algo femenino/a Muy femenino/a
75. ¿Qué tan frecuente, si hubiese pasado, fue usted víctima de bullying antes de los 18 años?
Frecuentemente Algunas veces Rara vez Nunca Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 78
Las siguientes preguntas son sobre tu vida actual.
76. La ciudad/municipio/pueblo o área donde usted vive, es o no, un buen lugar para que vivan…
BUEN LUGAR MAL LUGAR A. Minorías raciales y étnicas B. Personas gays, lesbianas o bisexuales C. Personas transgénero D. Inmigrantes de otros países
77. ¿Cuál de los siguientes enunciados, describe mejor su actual situación laboral? Por favor marque todas las que correspondan.
Empleado a tiempo completo por un empleador Empleado a tiempo parcial por un empleador Trabajador independiente Sin trabajo, y ha sido por 1 año o más Sin trabajo, y ha sido por menos de 1 año Ama/o de casa Estudiante Pensionado No puede trabajar debido a una discapacidad
78. ¿Cuál es su ingreso familiar mensual? Por favor incluya todos los ingresos de honorarios y sueldos de todos los miembros; el dinero que obtiene de miembros de la familia que viven en otros lugares y todas las demás fuentes de ingreso.
Menos de $781.242 $781.242 (Salario Mínimo Mensual Legal Vigente) Entre $781.242 y $1.000.000 Entre $1.000.000 y $2.000.000 Entre $2.000.000 y $3.000.000 Entre $3.000.000 y $4.000.000 Entre $4.000.000 y $5.000.000 Entre $5.000.000 y $6.000.000 Entre $6.000.000 y $7.000.000 Entre $7.000.000 y $8.000.000 Entre $8.000.000 y $10.000.000 Entre $10.000.000 y $15.000.000 Entre $15.000.000 y $20.000.000 Más de $20.000.000
79. Incluyéndose, cuántas personas (incluyendo los niños) viven de ese ingreso familiar? Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 79
80. ¿Cuál es su ingreso personal mensual? Por favor incluya todos los ingresos de honorarios y sueldos; dinero que obtiene de miembros de la familia que viven en otros lugares y todas las demás fuentes.
Menos de $781.242 $781.242 (Salario Mínimo Mensual Legal Vigente) Entre $781.242 y $1.000.000 Entre $1.000.000 y $2.000.000 Entre $2.000.000 y $3.000.000 Entre $3.000.000 y $4.000.000 Entre $4.000.000 y $5.000.000 Entre $5.000.000 y $6.000.000 Entre $6.000.000 y $7.000.000 Entre $7.000.000 y $8.000.000 Entre $8.000.000 y $10.000.000 Entre $10.000.000 y $15.000.000 Entre $15.000.000 y $20.000.000 Más de $20.000.000
81. ¿Cuál es su religión actual?
Católico Evangélico Testigo de Jehová Protestante (Bautista, Metodista, No confesional, Luterano, Presbiteriano, Pentecostal, Episcopal, reformado, Iglesia de Cristo, etc.) Judío Musulmán Mormón Budista Hare Krishna Hinduista Ateo (No cree en Dios) Agnóstico (No estoy seguro/a que exista un Dios) Espiritual Otro: ______Ninguno en particular
82. Pensando en cuando era un niño/a, ¿en qué religión creció?
Católico Cristiano Evangélico Testigo de Jehová Protestante (Bautista, Metodista, No confesional, Luterano, Presbiteriano, Pentecostal, Episcopal, reformado, Iglesia de Cristo, etc.) Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 80
Judío Musulmán Mormón Budista Hare Krishna Hinduista Ateo (No cree en Dios) Agnóstico (No estoy seguro/a que exista un Dios) Espiritual Otro: ______Ninguno en particular
83. Aparte de matrimonios y funerales, ¿Qué tan a menudo acude usted a servicios religiosos?
Más de una vez por semana 1 vez por semana 1 o dos veces al mes Pocas veces al año Raramente Nunca
84. Indique su estrato socioeconómico
1 2 3 4 5 6
85. Indique donde nació:
Colombia Venezuela Otro ¿cuál? ______
86. Si no nació en Colombia, desde que año vive en Colombia Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 81
87. Indique su estado civil
Soltero Casado Divorciado/separado Viudo Unión libre Otro
88. ¿Actualmente tiene pareja?
Si No (Skip to Q90)
89. En caso de tener pareja, ¿qué género es su pareja?
Hombre Mujer Transgénero
90. ¿Tiene usted hijos?
Si No
91. ¿En qué estás trabajando actualmente?
______
92. ¿Hay algo importante que nos quisieras contar o compartir y que no hayamos preguntamos en este cuestionario? ______
Resource List
La siguiente información será incluida como la página final del cuestionario.
Si siente que está en crisis, llame a una de estas líneas directas a continuación. Las personas han pedido ayuda con el abuso de sustancias, abuso sexual, problemas de pareja y familiares, orientación sexual, enfermedad, superación del abuso, depresión, ansiedad y enfermedad mental. Su llamada es confidencial.
LÍNEAS DE ATENCIÓN
BARRANQUILLA Y SOLEDAD:
Línea de la Vida: orientación y atención inmediata e integral en temas de salud mental, a la comunidad barranquillera en crisis de ansiedad, depresión, ideación suicida, violencia intrafamiliar Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 82
ya sea un caso personal o de un familiar, amigo, vecino o compañero laboral. La información que se suministre a los profesionales que atienden la línea es confidencial y debe ser bien soportada para brindar una adecuada asistencia.
Atención 24 horas: 3399999 Horario de atención: lunes a viernes 7:00 a.m. - 12:00 m / 1:00 p.m - 5:00 p.m Línea Atención al Ciudadano: (57+5) 3399888-3399889-3399890
CRUE: Centro Regulador de Urgencias y Emergencias Teléfonos: (5) 3309000 Extensión: 5131 (5) 3308100 - (5) 3308101 Horario de atención: 24 horas. Centros de Atención e Investigación Integral a las Víctimas de Delitos Sexuales (CAIVAS): proporciona un servicio oportuno y eficiente a las víctimas y personas involucradas en los delitos contra la libertad, integridad y formación sexual, trata de personas y violencia intrafamiliar, en un marco de respeto por la dignidad humana. Dirección: CARRERA 55 # 72-94. BARRANQUILLA (ATLÁNTICO) Teléfono: 3568331 Horario: LUNES A VIERNES DE 8:00 A.M. 5:00 P.M.
FISCALÍA GENERAL DE LA NACIÓN: Línea nacional gratuita (01 8000 9197 48) Desde su celular marque gratis al 122.
CARTAGENA:
Línea de atención en Salud Mental: Línea de vida: 125 Cartagena –suicidio Teléfonos: (5) 6645612 -(5) 6644675 Horarios de Atención: 7 días de la semana / 24 horas
Centro Regulador de Urgencias y Emergencias Teléfonos: (5)6645612 –(5) 6644675
Centros de Atención e Investigación Integral a las Víctimas de Delitos Sexuales (CAIVAS): Dirección: Crespo Cl 66 4-86 P-1 Tel. Teléfono: (5) 6560291. Horarios de Atención: 7 dias de la semana / 24 horas
FISCALÍA GENERAL DE LA NACIÓN: Línea nacional gratuita (01 8000 9197 48) Desde su celular marque gratis al 122. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 83
MEDELLÍN LÍNEA AMIGA PARA SALUD MENTAL Y FARMACODEPENDENCIA: orienta a los usuarios en temas relacionados con problemas como el alcoholismo, las drogas y el suicidio. Atención 24 horas: 4444448.
Centros de Atención e Investigación Integral a las Víctimas de Delitos Sexuales (CAIVAS): Dirección: Carrera 44a # 31-156, Medellín, Antioquia Horario de atención: lunes a viernes: 7:30 am a 7:30 p.m. Sábados: 7:30 a.m. a 2:30 p.m.
FISCALÍA GENERAL DE LA NACIÓN: Línea nacional gratuita (01 8000 9197 48) Desde su celular marque gratis al 122.
BOGOTÁ Linea 106: “El poder de ser escuchado” Linea de atencion, ayuda, intervencion psicosocial y/o soporte en situacion de crisis. Horario de Atención: 24 horas de domingo a domingo Jornada Continua. Whatsapp: 3007548933 Linea psicoactiva “Activa tu mente, transforma tu vida”: Aborda el consumo de sustancias psicoactivas. Teléfono: 018000112439. Horario de Atención: lunes a sábado de 7: 00 a.m. a 10:00 p.m. jornada continua.
Centros de Atención e Investigación Integral a las Víctimas de Delitos Sexuales (CAIVAS): Teléfono: 57 1 3750342 – 3750329 Dirección: Carrera 33 # 18-33 piso 2. FISCALÍA GENERAL DE LA NACIÓN: Línea nacional gratuita (01 8000 9197 48) Desde su celular marque gratis al 122. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 84
APPENDIX 3: STUDY QUESTIONNAIRE IN ENGLISH
SCREENER
QUESTION # QUESTION ELIGIBILITY
Which of these options best describes you? Lesbian Gay s_1 Bisexual Transgender Neither gay nor lesbian, that is heterosexual Something else, write here: ______
Which of this best describes yourself: Neither gay or lesbian, that is, heterosexual If s_sexid = a, not eligible s_sexid Lesbian If s_sexid = b, c, d, e = eligible Gay Bisexual
If s_sexid = eligible, 2 and 3 = any response, eligible.
If s_sexid= not eligible and 2 = a and 3 = a, not eligible
What sex were you assigned at birth, on your If s_sexid = not eligible and original birth certificate? s_sexatbirth If s_sexatbirth = b and 3 = b, Female not eligible Male If s_sexid = not eligible and s_sexatbirth = a and s_ genderid = b, eligible
If s_sexid = not eligible and If s_sexatbirth = b and s_ genderid = a, eligible
If s_sexid = not eligible and Which of the following terms best describes your s_sexatbirth = a or b, and current gender identity? s_genderid = c, or d eligible Woman
s_genderid Man If s_sexid=not eligible, and Trans woman (Male-to-female) s_sexatbirth=a or b, and s_ Trans man (Female-to-male) genderid=e, not eligible, but Non-binary/Genderqueer will take the demographic questions Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 85
QUESTION # QUESTION ELIGIBILITY
If s_yearborn> 2001, not What year were you born? eligible s_yearborn If s_yearborn = 2001 or less, eligible
What is your highest level of education? No education 1st grade 2nd grade 3rd grade If 4th grade or less, not s_educlevel 4th grade eligible 5th grade If 5th grade or more, eligible Secondary school Technical school University Post graduate
Where do you live? Barranquilla Bogotá If s_residence = g), not Cartagena s_residence eligible Medellín If s_residence= a)-f), eligible Soledad Another place in Colombia:______Outside of Colombia
QUESTIONNAIRE
ONLY LGB
For each of the following questions, please check the answer that best indicates your experience as lesbian, gay, or bisexual (LGB). We use “LGB” generically, to refer to the identity of a sexual minority with which you identify yourself.
TOTALLY SOMEWHAT SOMEWHAT TOTALLY DISAGREE AGREE DISAGREE DISAGREE AGREE AGREE
1. My sexual orientation is an insignificant part of who I am 2. My sexual orientation is a central part of my identity Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 86
TOTALLY SOMEWHAT SOMEWHAT TOTALLY DISAGREE AGREE DISAGREE DISAGREE AGREE AGREE
3. To understand who I am as a person, you should know that I am LGB 4. Being an LGB person is a very important aspect of my life 5. I think being LGB is an important part of me
Below are some questions about your growth and your sexual feelings from when you were younger. Again, we remind you that by “LGB” we mean the identity of the sexual minority with which you identify yourself.
6. At what age did you feel sexually attracted, for the first time, to someone of the same sex?
Age
I have never been attracted to someone of the same sex I do not know, I do not remember
7. At what age did you have, for the first time, had consensual sex with someone of the same sex?
Age
I have never had sex with consent with someone of the same sex I do not know, I do not remember
8. At what age did you have your first intimate relationship with someone of the same sex, where you both felt in love or romantically involved?
Age
I have never had an intimate relationship with someone of the same sex, where we both felt in love or romantically involved I do not know, I do not remember Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 87
9. At what age did you realize, for the first time, that you were LGB?
Age
I never realized that I am LGB I do not know, I do not remember
10. At what age did you say, for the first time, to a heterosexual friend that you were LGB?]
Age
I never told a straight friend that I am LGB I do not know, I do not remember
11. At what age did you say, for the first time, to a member of your family that you were LGB?
Age
I never told anyone in my family that I am LGB I do not know, I do not remember
12. How old were you when it became clear to you that someone in your family had realized that you were LGB before you told them?
Age
It never became apparent to me that someone in my family had realized that I am LGB before I told them I do not know, I do not remember
13. Now remember when you were in high school; how “out of the closet” were you?
Out of the closet for everyone at school Out of the closet for most of the school Out of the closet for some of the school Out of the closet for a few at school Out of the closet for no one at school Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 88
ONLY TRANS
14. At what age did you begin to feel that your gender was “different” from the one you were assigned at birth?
Age
I’ve never felt like this I do not know, I do not remember
15. At what age did you begin to think that you were transgender (even if you did not know the word)?
Age
I’ve never thought that I do not know, I do not remember
16. At about what age did you start telling others that you were transgender (even if you did not use that word)?
Age
I have not told others that I am transgender I do not know, I do not remember
EVERYONE
The following questions are about how you feel in the LGBT community. Please rate the following items according to your level of agreement.
TOTALLY TOTALLY AGREE DISAGREE AGREE DISAGREE 17. You feel you are part of the LGBT community 18. Participating in the LGBT community is something positive for you
19. You feel a bond with the LGBT community
20. You are proud of the LGBT community
21. It is important for you to be an activist in the LGBT community Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 89
22. If we worked together, lesbian, gay, bisexual, and transgender people could solve problems of the LGBT community……………………………………………
23. You feel that the problems faced by the LGBT community are also your own problems
The next questions are about your health.
24. In general, would you say that your health is ...
Excellent Very good Good Fair Poor
25. Regarding your physical health, including illnesses and physical injuries, in the last 30 days for how many days do you feel your physical health was not good?
Days
None
26. Now, think about your mental health, including stress, depression, and emotional problems. In the last 30 days, for how many days do you feel your mental health was not good?
Days
None
27. In the last 30 days, for how many days, did poor physical or mental health prevent you from carrying out your usual activities such as personal care, work, or recreational activities?
Days
None
28. Has a doctor, nurse or other health professional EVER told you that you had any of the following conditions? Please select all that apply to you.
Hypertension (high blood pressure) High cholesterol Heart disease Angina Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 90
Heart attack Cerebral ischemia Emphysema Asthma Ulcer Cancer Diabetes Prediabetes, impaired fasting glucose, glucose intolerance, borderline diabetes or high levels of blood sugar Arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia Blood clots in legs or lungs Osteoporosis or loss of bone density Thyroid problems Liver disease Chronic Obstructive Pulmonary Disease (COPD) Crohn’s disease or ulcerative colitis Kidney disease HIV/AIDS Another sexually transmitted infection (not including HIV/AIDS) Sleep disorder (for example, insomnia or sleep apnea) None of the above
The following questions are about how you have felt in the past 30 days. For each question, choose how often you have that feeling.
29. During the last 30 days, more or less, how often have you felt ...
VERY MOST SOME NONE ALL THE LITTLE OF THE OF THE OF THE TIME OF THE TIME TIME TIME TIME
A. Nervous
B. Hopeless
C. Restless or uneasy
D. Depressed; nothing could lift your spirits Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 91
E. That everything took too much effort
F. That nothing was worth it
The next questions are about alcohol and drugs.
30. How often do you drink a beverage that contains alcohol?
Never Once a month or less 2 to 4 times a month 2 or 3 times a week 4 or more times a week
31. How many drinks that contain alcohol do you drink on a normal day when you drink?
None 1 or 2 3 or 4 5 or 6 7 to 9 10 or more
32. How often do you drink six or more drinks on one occasion?
Never Less than monthly Monthly Weekly Daily or almost daily Next, we have some questions about drugs. Respond in the most correct and honest way possible indicating what is the right answer for you. For the following questions, we refer to drugs such as marijuana, methamphetamine, crack, heroin, ecstasy, GHB, and pills, such as sleeping pills and painkillers. These are not considered drugs if prescribed by a doctor and taken at the prescribed dose.
33. How often do you use drugs other than alcohol?
Never Once a month or less 2 to 4 times a month 2 to 3 times a month 4 or more times a week Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 92
34. Do you consume more than one type of drug on the same occasion?
Never Once a month or less 2 to 4 times a month 2 to 3 times a month 4 or more times a week
35. On a normal day when you use drugs, how many times do you do it?
0 1-2 3-4 5-6 7 or more
36. How often are you under the intense effect of drugs?
Never Less than once a month Every month Every week Daily or almost daily
37. In the last year, have you felt that your desire to use drugs was so strong that you could not resist it?
Never Less than once a month Every month Every week Daily or almost daily
38. Has it happened in the last year that you have not been able to stop using drugs once you started to use them?
Never Less than once a month Every month Every week Daily or almost daily Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 93
39. How often in the last year have you used drugs and then stopped doing something you should have done?
Never Less than once a month Every month Every week Daily or almost daily
40. How often in the last year have you needed to use a drug in the morning after a day of heavy drinking?
Never Less than once a month Every month Every week Daily or almost daily
41. How often in the past year have you had feelings of guilt or remorse for having used drugs?
Never Less than once a month Every month Every week Daily or almost daily
42. Have you or any other person suffered harm (mental or physical) because you used drugs?
No Yes, but not in the last year Yes, in the last year
43. Has a family member or friend, doctor or nurse, or any other person, expressed concern about your drug use or told you that you should stop using?
No Yes, but not in the last year Yes, in the last year
44. Have you ever had thoughts about committing suicide in your life?
No Yes
45. Did you ever intend to act on thoughts of wanting to be dead or trying to kill yourself?
No Yes Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 94
46. Have you ever thought about how you could commit suicide (for example, taking pills, shooting yourself) or have you devised a plan to commit suicide?
No Yes
47. Have you ever tried to commit suicide (that is, you deliberately hurt yourself with at least some intention to die)?
No go to question 49 Yes
48. If you answered YES in question 47, what were the most serious injuries you had from a suicide attempt?
I had no injuries A very mild injury (for example, superficial scratches, mild nausea) Minor injuries (for example, sprain, first-degree burns, superficial injuries) Moderate injuries that did not require overnight hospitalization (for example, broken bones, second-degree burns, stitches, bullet lodged in an arm or leg) Moderate injuries that required hospitalization during the night (for example, major fracture, third-degree burns, coma, bullet lodged in the abdomen or chest, minor surgery) Serious injuries that required treatment in an intensive care unit to save your life (for example, major skull or spine fracture, severe burns, coma that required a respirator, bullet in the head, major surgery).
49. Have you ever done something to hurt yourself on purpose, but not wanting to die (for example, cutting yourself, hitting yourself or burning yourself)?
No Yes
ONLY LGB
The next section deals with experiences that may have happened throughout your life. The first questions are about how much you are out of the closet for the following groups of people. We use “LGB” generically to refer to the identity of the sexual minority with which you identify yourself. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 95
50. Are you out of the closet for everyone, for the majority, for some or for any of the following groups of people ...
DON’T KNOW/ ALL MOST SAME NONE DOES NOT APPLY
Family
Heterosexual friends
Coworkers
Health service professionals, such as doctors, nurses, psychologists, etc.
ONLY TRANS
Please rate your level of agreement with the following items.
51. Because I do not want others to know my gender identity/history…
NEITHER STRONGLY STRONGLY DISAGREE AGREE NOR AGREE DISAGREE AGREE DISAGREE A. I do not talk about certain experiences from my past or I change parts of what I will tell people...... B. I change my way of speaking C. I pay special attention to my clothes or appearance D. I avoid exposing my body, like wearing a swimsuit or undressing in the changing rooms E. I change the way I walk, gesture, feel, or stand up Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 96
EVERYONE
52. How often can people tell that you are LGB or transgender, even if you do not tell them?
Forever Most of the time Sometimes Occasionally Never
ONLY LGB
Below are statements that represent how you think that non-LGBT people can think about LGB people. Please rate the following items according to their degree of agreement.
NEITHER STRONGLY AGREE SOMEWHAT STRONGLY DISAGREE DISAGREE NOR AGREE AGREE DISAGREE 53. Most people where I live think LGB people are less than other people...... 54. Most employers where I live would hire openly LGB people if they are qualified for the job.. 55. Most people where I live would not want someone who is openly LGB to take care of their children......
ONLY LGB
The following questions are about how you feel about being LGB. Please rate the following according to your level of agreement. Again, we say that “LGB” refers to the identity of the sexual minority with which you identify yourself.
TOTALLY SOMEWHAT SOMEWHAT TOTALLY DISAGREE AGREE DISAGREE DISAGREE AGREE AGREE
56. I tried to stop being attracted to people of the same sex Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 97
57. If someone offered me the opportunity to be completely heterosexual, I would accept the opportunity 58. I wish I was not LGB
59. I feel that being LGB is a personal deficiency for me
60. I would like professional help to change my sexual orientation from LGB to heterosexual
ONLY TRANS
61. Please rate your level of agreement with the following items.
TOTALLY SOMEWHAT SOMEWHAT TOTALLY DISAGREE AGREE DISAGREE DISAGREE AGREE AGREE A. I resent (hate) my gender identity B. Being transgender makes me feel like a freak C. I feel like an outcast being transgender D. I wonder why I can’t just be normal? E. I feel that being transgender is embarrassing F. I envy people who are not transgender Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 98
ONLY LGB
62. Have you ever received treatment from someone who tried to change your sexual orientation (to try to become heterosexual)? If yes, check all the boxes that apply.
No Yes, from a health professional (such as a psychologist or a counselor without religious emphasis) Yes, from a religious leader (such as a pastor, a religious counselor, a priest)
ONLY TRANS
63. Have you ever received treatment from someone who tried to make you identify only with your assigned sex at birth (in other words, try to prevent you from being transgender)? If yes, check all the boxes that apply.
No Yes, from a health professional (such as a psychologist or a counselor without religious emphasis) Yes, from a religious leader (such as a pastor, a religious counselor, a priest)
EVERYONE
The following statements are about your life experiences and the things that happened to you. This is a sensitive issue and some people may feel uncomfortable with these questions.
64. Since the age of 18, how often has any of the following happened to you?
THREE NEVER ONCE TWICE OR MORE TIMES
A. You were beaten or physically attacked (Skip to C, if Never)
B. Was this situation of violence caused by armed groups outside the law (such as guerrillas and paramilitaries, among others?) � Yes � No
C. You were sexually assaulted (Skip to E, if never)
D. Was this situation of violence caused by armed groups outside the law (such as guerrillas and paramilitaries, among others?) � Yes � No E. Your property was stolen, vandalized, or intentionally damaged (Skip to G if never). Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 99
F. Was this situation of violence caused by armed groups outside the law (such as guerrillas and paramilitaries, among others?) � Yes � No G. Someone tried to attack you, steal or damage your property, but was not successful (Skip to I, if never) H. Was this situation of violence caused by armed groups outside the law (such as guerrillas and paramilitaries, among others?) � Yes � No
I. Someone threatened you with violence (Skip to K if never)
J. Was this situation of violence caused by armed groups outside the law (such as guerrillas and paramilitaries, among others?) � Yes � No K. Someone insulted or verbally assaulted you (Skip to M if never) L. Was this situation of violence caused by armed groups outside the law (such as guerrillas and paramilitaries, among others?) � Yes � No
M. Someone threw an object at you (Skip to 65 if never)
N. Was this situation of violence caused by armed groups outside the law (such as guerrillas and paramilitaries, among others?) � Yes � No
The following questions are about experiences with the police.
65. In the last year, how often have the police or state officials been verbally abusive to you?
Never Once Twice Three or more times
66. In the last year, how often have the police or state officials been physically abusive to you?
Never Once Twice Three or more times Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 100
The following questions are about how you were treated by others.
67. Since the age of 18, how many times were you fired from your job or denied a job?
Never Once Twice Three or more times
68. Since the age of 18, how often have you been denied a promotion or received a negative evaluation?
Never Once Twice Three or more times
69. Since the age of 18, how often did a landlord or real estate agency stop you from moving or buying a house or apartment?
Never Once Twice Three or more times
70. In your daily life, during the last year, how often has any of the following situations happened to you?
OFTEN SOMETIMES RARELY NEVER
A. You were treated with less courtesy than others B. You were treated with less respect than others C. You have received worse service than others in restaurants or stores D. People have acted as if they thought you are not smart E. People have acted as if they were afraid of you F. People have acted as if they thought you were dishonest G. People have acted as if they were better than you H. They called you by offensive nicknames or insulted you I. They have threatened or harassed you Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 101
The following questions are about your childhood experiences.
71. As a child, my favorite toys were ...
Always masculine Usually masculine Equally masculine and feminine Usually feminine Always feminine Neither masculine nor feminine
72. As a child, the TV or movie characters you imitated and admired were ...
Always boys and men Usually boys and men Women/girls and men/boys alike Usually girls/women Always girls/women You did not imitate or admire any character on television or in movies
73. In role playing, you took the role of…
Only men and boys Usually men and boys Women/girls and men/boys alike Usually girls/women Always girls/women I did not play these types of games
74. As a child I felt…
Very masculine Somewhat masculine Masculine and feminine alike Somewhat feminine Very feminine
75. How often, if it happened, were you a victim of bullying before age 18?
Frequently Sometimes Rarely Never Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 102
The following questions are about your life currently.
76. Is the city/municipality/town or area where you live a good place for the following people to live...
GOOD BAD PLACE PLACE A. Racial and ethnic minorities B. Gay, lesbian, or bisexual people C. Transgender people D. Immigrants from other countries
77. Which of the following statements best describes your current employment situation? Please check all that apply.
Employed full-time by an employer Employed part-time by an employer Independent worker Out of work for 1 year or more Out of work for less than 1 year Homemaker Student Retired Unable to work due to a disability
78. What is your monthly family income? Please include all income from salaries and honoraria of all members, the money you receive from family members who live elsewhere, and all other sources of income.
Less than $781,242 $781,242 (Minimum Legal Effective Monthly Salary) Between $781,242 and $1,000,000 Between $1,000,000 and $2,000,000 Between $2,000,000 and $3,000,000 Between $3,000,000 and $4,000,000 Between $4,000,000 and $5,000,000 Between $5,000,000 and $6,000,000 Between $6,000,000 and $7,000,000 Between $7,000,000 and $8,000,000 Between $8,000,000 and $10,000,000 Between $10,000,000 and $15,000,000 Between $15,000,000 and $20,000,000 More than $20,000,000
79. Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 103
80. Including you, how many people (including children) live on that family income?
81. What is your monthly personal income? Please include all income from salaries and honoraria, the money you receive from family members who live elsewhere, and all other sources.
Less than $781,242 $781,242 (Minimum Legal Effective Monthly Salary) Between $781,242 and $1,000,000 Between $1,000,000 and $2,000,000 Between $2,000,000 and $3,000,000 Between $3,000,000 and $4,000,000 Between $4,000,000 and $5,000,000 Between $5,000,000 and $6,000,000 Between $6,000,000 and $7,000,000 Between $7,000,000 and $8,000,000 Between $8,000,000 and $10,000,000 Between $10,000,000 and $15,000,000 Between $15,000,000 and $20,000,000 More than $20,000,000
82. What is your current religion?
Catholic Christian Evangelical Jehovah’s Witness Protestant (Baptist, Methodist, Non-denominational, Lutheran, Presbyterian, Pentecostal, Episcopal, Reformed, Church of Christ, etc.) Jewish Muslim Mormon Buddhist Hare Krishna Hindu Atheist (You do not believe in God) Agnostic (You are not sure a god exists) Spiritual Other: ______None in particular
83. Thinking about when you were a child, in what religion were you raised?
Catholic Christian Evangelical Jehovah’s Witness Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 104
Protestant (Baptist, Methodist, Non-denominational, Lutheran, Presbyterian, Pentecostal, Episcopal, Reformed, Church of Christ, etc.) Jewish Muslim Mormon Buddhist Hare Krishna Hindu Atheist (You do not believe in God) Agnostic (You are not sure a god exists) Spiritual Other: ______None in particular
84. Apart from marriages and funerals, how often do you go to religious services?
More than once a week One time a week Once or twice a month Occasionally during the year Rarely Never
85. Indicate your socioeconomic status.
1 2 3 4 5 6
86. Indicate where you were born:
Colombia Venezuela Another one? ______
87. If you were not born in Colombia, you have lived in Colombia since: Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 105
88. Indicate your marital status
Single Married Divorced/separated Widowed Free union [common-law union] Other
89. Do you currently have a partner?
Yes No (Skip to Q90)
90. If you have a partner, what is the gender of your partner?
Man Woman Transgender
91. Do you have children?
Yes No
92. What is your current job?
______
93. Is there anything else you would like to share?
______
Resource list in Spanish is attached to the end of the questionnaire: See Spanish version Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 106
APPENDIX 4: QUESTIONNAIRE MEASURE SOURCES IN ENGLISH
STUDY QUESTIONNAIRE ITEMS AND SOURCES CONSTRUCT QUESTION # SOURCE Identity Sexual orientation and S_1 Created by the Colombia Collaborative team gender identity Part one of a two-step approach on gender identity. The GenIUSS Group (2014). Best practices for asking questions to identity transgender and other gender minority respondents on population- Sex assigned at birth S_SEXATBIRTH based surveys. J.L. Herman (Ed.). Los Angeles, CA: The Williams Institute. Retrieved from: http://williamsinstitute.law.ucla.edu/wp- content/uploads/geniuss-report-sep-2014.pdf Part two of two-step approach on gender identity. The GenIUSS Gender identity S_GENDERID Group (2014) – see Q27 for full reference. Answer options slightly modified. Modified from SMART (2009). Best practices for asking questions Sexual orientation about sexual orientation on surveys. Los Angeles, CA : The Williams S_SEXID identity Institute. Retrieved from: http://williamsinstitute.law.ucla.edu/wp- content/uploads/SMART-FINAL-Nov-2009.pdf Mohr, J.J. & Kendra, M.S. (2012). The Lesbian, Gay, & Bisexual Identity Centrality Identity Scale (LGBIS). Measurement instrument database for the Q1-Q5 subscale Social Science. Retrieved from: http://www.midss.org/sites/default/ files/lgbis.pdf Modified from Martin JL, & Dean L (1987). Summary of measures: Coming out milestones Q6-Q12 Mental health effects of Aids on at-risk homosexual men. Reference type: Unpublished work Outness in high school Q13 Created by Generations Study team Gender identity Adapted from Beemyn, G. & Rankin, S. (2011). The Lives of Q14-Q16 milestones Transgender People. New York, N.Y.: Columbia Press. Frost, D.M. & Meyer, I.H. (2011). Measuring community connectedness among diverse sexual minority populations. Journal of Sex Research, 49(1). 36-49. Retrieved from: http://dx.doi.org/10.1
Community 080/00224499.2011.565427 Q17-Q23 connectedness The team used a 7 items instead of the 8 items listed in Frost & Meyer (2011). The last item was not included in the survey because the team was not able to personalize the items to gender and sexual orientation in a way that was useful. Health Outcomes General health and Center for Disease Control and Prevention(CDC) – Behavioral Risk health related quality Q24-Q27 Factor Surveillance System (BRFSS) Survey (2014). of life Modified from NHIS (2014) Adult Survey- Health Outcomes section. Physical health Q28 Generations Study team created a single check list based on NHIS outcomes (2014). Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 107
STUDY QUESTIONNAIRE ITEMS AND SOURCES CONSTRUCT QUESTION # SOURCE National Comorbidity Survey. Kessler 6 - Self Report Q1 (a)-(f). Kessler-6 Q29 Retrieved from: http://www.integration.samhsa.gov/images/res/ K6%20Questions.pdf Alcohol Use Disorder Identification Test (AUDIT-C)
Retrieved from: http://www.integration.samhsa.gov/images/res/ tool_auditc.pdf Alcohol Use Q30-32 A slight modification was made by adding answer option 0.NONE because original AUDIT-C has no skip pattern which could cause confusion to respondents Berman, A.H., Bergman, H., Palmstierna, T., & Schlyter, F. (2003). The DUDIT Q33-Q43 Drug Use Disorders Identification Test (DUDIT) Manual. Retrieved from: http://www.paihdelinkki.fi/sites/default/files/duditmanual.pdf Modified from Army – Study to Assess Risk and Resilience in Service Suicide Behavior Q44-Q49 Members (STARRS) Instrument. Retrieved from: http://starrs-ls.org/ sites/default/files/2016-03/army_starrs_aas_instrument.pdf Stressors Meyer, I.H., Rossano, L., Ellis, J.M., Bradford, J.(2002). A brief telephone interview to identify lesbian and bisexual women in Concealed Sexual Q50 random digit dialing sampling. Journal of Sex Research, 39. 139-144. Identity (“Out”) One item, degree of being out to “gay, lesbian, or bisexual friends” was not included in the Generations Study. Testa, R. J., Habarth, J., Peta, J., Balsam, K., & Bockting, W. (2015). Gender Identity Non- Q51 Development of the Gender Minority Stress and Resilience Measure. disclosure Psychology of Sexual Orientation and Gender Diversity, 2(1), 65 Modified from Grant, J.M., Mottet, L.A., Tanis, J., Harrison, J., Herman, J.L., & Keisling, M. (2012). Injustice at Every Turn, A report on the Visibility/Passing Q52 National Transgender Discrimination Survey. National Center for Transgender Equality. Retrieved from: http://www.transequality.org/ sites/default/files/docs/resources/NTDS_Report.pdf Herek (2008), Hate Crimes and Stigma-Related Experiences Among Sexual Minority Adults in the United States. Journal of Interpersonal Violence. Felt Stigma Q53-Q55 Retrieved from:
http://jiv.sagepub.com/content/ early/2008/04/07/0886260508316477.full.pdf+html Herek et al (2009), Internalized stigma among sexual minority Internalized Q56-Q60 adults: Insights from a social psychological perspective. Journal of Homophobia-Revised Counseling Psychology, 56(1). DOI: 10.1037/a0014672 Testa, R. J., Habarth, J., Peta, J., Balsam, K., & Bockting, W. (2015). Internalized Q61 Development of the Gender Minority Stress and Resilience Measure. Transphobia Psychology of Sexual Orientation and Gender Diversity, 2(1), 65. Meyer, I.H., Bockting, W.O., Herman, J.L., Reisner, S.L. & Choi, S.K. Conversion treatment Q62-Q63 (2016).TransPop Study Questionnaire for Transgender-Identified Adults and Measure Sources. Unpublished Stress, Health, and Well-being of LGBT People in Colombia: Results from a National Survey | 108
STUDY QUESTIONNAIRE ITEMS AND SOURCES CONSTRUCT QUESTION # SOURCE Herek (2009), Hate Crimes and Stigma-Related Experiences Among Victimization and Q64A, C, E, G, I, K, M Sexual Minority Adults in the United States. Journal of Interpersonal Discrimination Violence, 24(1). Victimization by Armed Q64B, D, F, H, J, L, N Created by the Colombia Collaborative team groups English, D., Bowleg, L., Del Río-gonzález, A. M., Tschann, J. M., Agans, R. P., & Malebranche, D. J. (2017). Measuring Black men’s police- Police Interaction Q65-Q66 based discrimination experiences: Development and validation of the Police and Law Enforcement (ple) Scale. Cultural diversity & ethnic minority psychology, 23(2), 185-199. Herek (2009), Hate Crimes and Stigma-Related Experiences Among Events Q67-Q69 Sexual Minority Adults in the United States. Journal of Interpersonal Violence, 24(1) and Police Public Contact Survey (2011) Modified from Williams, D.R., Yu, Y., Jackson, J.S. & Anderson, N.B (1997). Racial differences in physical and mental health: Everyday Discrimination Q70 Socioeconomic status, stress, and discrimination. Journal of Health Psychology, 2(3). Selected measure from Zucker, K.J., Mitchell, J.N., Bradley, S.J., Childhood gender Tkachuk, J. Cantor, J.M. & Allin, S.M.(2006), The Recalled Childhood Q71-Q74 conformity Gender Identity/Gender Role Questionnaire: Psychometric properties. Sex Roles, 54(7). Meyer, I.H., Bockting, W.O., Herman, J.L., Reisner, S.L. & Choi, S.K. Bullying Q75 (2016).TransPop Study Questionnaire for Transgender-Identified Adults and Measure Sources. Unpublished Neighborhood Answer options modified from Gallup World Poll (2008) survey Q76 acceptance question Demographics Year of birth S_YEARBORN National Survey of Drug Use and Health (2014) Education S_EDUCLEVEL Created by the Colombia Collaborative team Residence S_RESIDENCE Created by the Colombia Collaborative team Employment Q77 Gallup Survey Income Q78-Q80 Created by the Colombia Collaborative team Modified from Pew Research Center (2013)- A survey of LGBT Religiosity Q81-Q83 Americans Socioeconomic status Q84 Created by the Colombia Collaborative team Nativity Q85-Q86 Created by the Colombia Collaborative team Marital status Q87 Created by the Colombia Collaborative team Relationship status Q88 Created by the Colombia Collaborative team Gender of partner Q89 Created by the Colombia Collaborative team Children Q90 Created by the Colombia Collaborative team Type of job Q91 Created by the Colombia Collaborative team